• What a Broken Back Taught Me About UX in Healthcare

    As the daughter of an Emergency Room doctor and nurse who wanted me to follow their lead into medicine, I had a somewhat unusual childhood. I experienced my first human dissection at age eleven and treated a simulated cerebral aneurysm before I could drive. While I was being molded into the future Dr. Valentine through every “doctor camp” offered in North America, I was taking mail-order art classes and attempting to sell my masterpieces in a local restaurant. I was expected to become a doctor, but my true passion lay in making things. 

    Medicine seemed like the ‘real’ career path and making things, a hobby on the side. I was all set to head off to the state university for pre-med studies, but as the time grew closer to graduation I realized I wouldn’t survive without a more creative degree, and found Parsons the School for Design. I boldly challenged the familial expectation to become a doctor, moving to New York City to become an interior designer and make things pretty. 

    During the summers, I would work at a snowboard camp in Oregon, returning to school with lungs full of fresh air and a head full of fresh perspective.  One summer ended abruptly and unexpectedly from a snowboarding accident. After landing on my spine on the edge of a snowboard rail, I landed myself in the local hospital.

    My experience in that emergency room changed my perspective on design forever. Within the chaotic environment of the ER, it seemed all the players within this system had no idea what their roles were or how to interact with me—the patient. Processes were so broken that I almost ended up in the Operating Room for surgery instead of going to Radiology to get a basic x-ray. I could not understand how professionals who were there to save lives—and who worked in this environment every day—seemed utterly incompetent. That’s when I realized all the mistakes I was witnessing were not of human error, but of design flaw. Poor design of patient I.D. bracelets lead me to the O.R. Bad space design and planning caused treatment delays when staff had to run back and forth for supplies. On top of it all, before getting a valid diagnosis, I was placed on a temporary ventilator leaving me unable to communicate, completely helpless, and forced to put my life in their hands.

    Going through that experience is how I ended up as a UX designer. I recognized that design had a greater purpose than making things pretty and that understanding user needs and behaviors was an integral part of design to not only fix broken systems but to create new and better experiences, in a lasting way. 

    I began my UX career working internally within the Design Strategy team, part of the Strategic Planning & Innovation group, at Memorial Sloan-Kettering Cancer Center. MSKCC is a top specialized healthcare organization heavily focused on research, innovation, and leadership within cancer care. The team’s mission was clear and simple: improve the patient's experience, whether through direct services or large-scale initiatives that would have a profound impact on the whole institution. We explored how we could create better experiences through service, space, communication, and interaction design that would improve lives, increase survival rate, or decrease risk for error or patient harm.

    While my work at MSKCC was exciting, challenging, and meaningful, I was eager to expand my outlook. I was looking for broader understanding on design, people, and different types of problems, which lead me to Adaptive Path. While I am here, I hope to gain a more extensive perspective on UX and service design in healthcare. I hope that more exposure to other industries will grant me deeper insight into designing better services and experiences for people, in and outside of healthcare.

    Here are some UX-in-healthcare things I have been thinking about lately: 

    ► Everyone is jumping on the “mobile and health IT” bandwagon, but it seems there is very little thought (and money) being put into an integrated  cross-channel strategy and continuity for patients and care providers.

    ► Because consumers are becoming more empowered, the traditional delivery models of healthcare are changing. This is going to have major impact on our healthcare system—from cost to patient experience.

    ► A patient’s frame of mind can change on a daily basis based on how they feel that day, progression of their disease, what treatment they are on, or if they were given good or bad news—making UX an even more challenging feat in healthcare. 

    ► I believe students could be the key to major healthcare change. This is purely from experience, but decision-making stakeholders do not fear “crazy innovative” ideas coming from students and may even feel inspired. Healthcare leaders are sometimes more willing to play in a workshop when it is lead by students. 

    ► I believe UX and Industrial Engineering can be a power couple when married appropriately. In many instances I’ve seen that the streamlining of processes and more efficient thinking about utilization have resulted in better experiences for patients. An overwhelmed patient will immediately recognize discontinuity, repetition, and a broken flow in their experience.

    ► Adoption is difficult unless the doctors are on board. This does not apply to all UX and design in healthcare scenarios and I don’t know if I believe it 100%, but it was definitely something I was seeing a lot when working internally. Everyone else could believe in a concept, but if the doctor did not, he or she could easily persuade the patient otherwise. Patients put a lot of trust in their doctor being their main source of information in the healthcare space. If doctors are not endorsing the idea, the value may not be apparent. (Maybe big Pharmaceutical companies knew about this from the start?)

    I'll be writing more about this topic and would love to hear your thoughts about UX in healthcare. Leave some comments! 

    There are 6 thoughts on this idea

    1. Adam

      WOW! this is great! i was speaking to a spine surgeon about a new project. They are really excited about getting into “Apps” “Mobile”, but dont really know where to begin. I am really looking forward to your posts and i will share them with the spine surgeon(s) organization and hospitals so they can have a better understanding of how design can help organizations better!

    2. Melissa

      Toi, thanks so much for sharing this post and the points you brought up regarding healthcare UX and designing for health.

      I agree that there is little thought and money on integrated cross-channel strategy/continuity. Speaking from a technology/design perspective, things are rather fragmented in healthcare, and I think that a contributing factor to this fragmentation (lack of continuity) is poor interoperability between platforms and technologies in healthcare (perhaps also in the “interoperability of interactions/experiences in healthcare”). For instance, we have a plethora of mobile and health IT ventures and technologies. In the consumer health sensors realm, we have a lot of great individual products that track metrics like sleep and physical activity. But how many are designed to share data with other product platforms? Where’s the integration point? Or API? And how will users get the big picture view of their health if their sleep data is stored and analyzed independent of their exercise data? Even more so, how can clinicians use this information to better understand their patients?

      This brings me to another point you mentioned about a patient’s frame of mind that changes on a daily basis. Currently, medicine has a very quantitative and static “snapshot” view of a patient. Something like a series of blood test or scans/imaging are a single sliver in the dynamic and constantly changing status of a patient. There is little account for social, psychological and environmental factors that could have a considerable affect on a patient’s progression and well being. Could more dynamic views of patients improve care? What impact could social, psychological and environmental considerations potentially have on care and delivery of care? What would something like this look like?

      Your articulation of the combination of UX and systems/industrial engineering is spot on. There’s benefit to optimizing and streamlining that industrial engineering brings, and a human-centric focus that UX brings. While UX certainly touches on the notions of accessibility and usability, to see an entire system and its processes can improve experience and flow.

      Adoption continues to be a challenge in various areas of UX/design in healthcare, and I think that this can be improved by aligning the process of adoption with clinicians’ mental models, making considerations for their time, knowledge and technology constraints, and designing the process of buy-in/endorsement for “ease of use”.

      Hope to see more great thoughts on this topic!

    3. Betsey Biggs

      Toi, as someone who is increasingly interested in how UX can improve real world situations (and not just a company’s bottom line), I really enjoyed this. I’m curious how the UX community might benefit from discussion with folks trying to do innovative work in the medical humanities, and vice versa. I heard a really wonderful talk from a doctor/novelist at Brown University connecting an understanding with fiction and narrative with diagnosis. It seems to me that since patients, doctors, nurses and all the other participants in a medical scenario are telling themselves stories of what’s going on, that a newly designed process might take this kind of narrative into consideration. I look forward to hearing more about improvements in this area!

    4. Roy

      Good thoughts.

      I had a similar medical emergency and, as a UX person, I couldn’t help but notice the glaring, head-slapping design and communication problems that were swirling around me. Freaking unbelievable. We’re talking about doctors and nurses who were already frazzled at the end of a long day trying to make sense of poorly designed systems and bad info while under immense stress.

      How could this NOT affect patient outcomes?

      They NEED good design. They should demand it.

      Most glaring was the utter lack of information sharing. My primary physician’s clinic had 1/3 of my info, the hospital 1/3, and the specialists the last 1/3. The best sharing and decisions happened face-to-face.

      I had at least 1 unnecessary CT scan because of bad design and poor communication.
      Too much seemed to depend on a doctor’s internal, proprietary knowledge, too.

      I agree with Melissa. The info available often doesn’t tell the whole story or even the right story. Even complete info may not be presented in a way that is useful.

      Then there were the little physical design issues in my room, like the bathroom threshold that tripped anyone pulling around an IV stand, or bed side tables that were so low you couldn’t reach the phone when it rang, or the myriad, hard-to-reach mystery ledges that seemed to serve no purpose other than harbor superbugs left by the TB patient that last used the room.

      There are big UX mountains to climb in the medical fields!

    5. Toi

      Thanks everyone for your great feedback and lively discussion. I know UX in healthcare is a hot topic right now and I am glad we are all eager and excited to tackle all of the (what seems infinite) issues and opportunities.

      Roy, thanks for sharing your experience as well. I know we are not alone, but it is good to bring these stories to the forefront as they are what really resonate and stay with people. I have many more stories to come for thinking about / tackling space and communication design in healthcare to increase positive patient outcomes. It really is amazing how the power of design can increase survival rates. Now it is just a matter of showing tangible results to spread the word.

      I think a major cause for all of the disconnect (in technology, information sharing, and even physical space details) is how complex of a system healthcare really is and the lack of roles to manage the system holistically. Luckily for us and anyone else who has the misfortune of finding themselves in a hospital or as a patient, there are many large healthcare organizations who are now creating multi-disciplinary departments to address this.

    6. Alexandra

      I really enjoyed your personal insights into the world of innovation and UX within healthcare systems! I am currently a graduate student at University of the Arts in Philadelphia in the MiD (Master of Industrial Design) program. We study how to use the traditional design process and apply it to humans and organizational structures (our program name is bit misleading). A lot of what we study is relatable to UX/UI.

      Last semester myself and team of 6 fellow students, worked with a large philadelphia healthcare system. We were charged with the task of making their online systems function better, but what we found was a greater challenge.

      After doing ethnographic research (interviewing, observing, using cultural probes) into the ways employees were working, we uncovered many issues with their culture, internal and external communication, learning and time. This synthesis pointed away from the use of digital interfaces. Most employees said they had enough to do on the computer and really value their co workers and the times they get to interact with them face to face to share information. After all, they are human.

      We hosted a workshop for employees about new ways of using the design process to help them innovate within their departments. The workshops were a huge success and peaked the administration’s interest in using design thinking, instead of six sigma in healthcare innovation.

      We ran into some problems though, and I don’t agree with the statement about “decision-making stakeholders” not fearing students innovative ideas. Students may be the key to solving these problems, as I think we provided a lot of great insights, but fear of change is a tough feeling to overcome. Most of our semester was spent showing the organization what we do and why its valuable. We never had access to patients and they were very conservative when it came to who we spoke with, presented too and interacted with.

      Although, once we broke through those barriers, we were able to get them to “play” in the workshops and some of my classmates continued working with that organization this semester, but within the HR department. All in all this was a great experience, but a bit of a frustrating one. It is difficult to see the changes that need to happen and want to help, only to be stopped by a fear of change within a huge organization. The anxiety of change inhibits innovation, although they may see a need for it and even set up a center for it.

      My classmates and I have produced a book documenting our process working with a healthcare organization that will be posted on Issu within the week.

      Thanks for the well written article!

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