Healthcare that works: How human-centered design aligns people, processes and technology
In the United States today, we are living through a dramatic transformation of healthcare. The move to compensation based on outcomes, electronic health records (EHR), telemedicine and patient self-reporting/tracking are intended to motivate patients to play a larger part in their healthcare. Yet, despite a projected $22 billion dollars spent in our country to continue the move to electronic health records in 2015, few would say we are delivering patient-centered experiences.
While the intent and money are there, the experience seems as overwhelming as ever. This is true not only for patients, but also for doctors and nurses, who report general dissatisfaction with the systems intended to support and improve patient outcomes.
According to a recent study published in the International Journal of Health Services, “American doctors are drowning in paperwork.” Rather than the systems working for them, many doctors perceive themselves to be working for the systems.
In a recent New York Times opinion piece “Why Health Care Tech is Still So Bad,” Dr. Robert Wachter recounts how a young patient was given a 39-fold overdose of a common antibiotic due to a screen’s confusing setting to “milligrams per kilogram.” What was most disturbing about this was alarms had been going off, yet were ignored. Why? Because in his own hospital, he estimated health providers were subject to some 2.5 million false alarms every month.
One can easily imagine how every alarm was devised in response to a perceived need to alert providers that made sense, each in isolation. Yet it’s clear in this example – and for anyone who has recently visited a major hospital – that what’s been delivered is not only unhelpful, but at times, actively dangerous.
Edward Tufte, a Yale Professor Emeritus of political science, statistics and computer science said, “Chaos and confusion are not attributes of information. They are failures of design.”
What can be done? Human-centered design is both a way of thinking and a process that seeks to understand how complex systems – made up of people, workflows, processes and technologies – can be synchronized to deliver a desired experience or outcome.
I believe this perspective has been missing from the discussion of healthcare. Rather, we’ve allowed technology-first approaches to dominate. To date, little consideration has been given in the incentives in the move to EHRs health records to make patient outcomes (or experience!) the focus of attention. Instead, the first goal has been to get the technology in place and then, essentially, connect the dots to outcomes at some future date.
As such, the bureaucracy accountable to ensure a return on investment has imposed a checklist mentality to ensure the technology is used. I view the Stage 2 Meaningful Use guidelines in this light. Well-intentioned though they may be, they are an overly specific, “one-size-fits-all” approach that appears to have less to do with patient outcomes, and more to do with measuring and checking off what’s measurable.
In essence, a human-centered perspective begins not by asking people to adapt to a technological (or bureaucratic) solution, but rather seeks to identify, understand and empathize with the needs, desires, perspectives and lived contexts of people first. Technology, workflow and processes are then bent around the needs of people, rather than the other way around.
So, where to begin? The first step is to learn through asking, listening and observing. Good design is for someone, it’s not something done to them. Just as important as deeply understanding, and ultimately empathizing, with patients, doctors and nurses, is to understand the contexts of use. As the example of the ignored alarms shows, numerous well-intentioned elements can have unintended – indeed disastrous – consequences, because they’ve been considered in isolation. Design is about thinking about the where and when, as much as the who.
With this perspective, we can begin the process of designing holistic experiences that take account of real-world needs and contexts. But, again, it’s not about the “designer-guru” providing all the answers. Rather, the process of co-design involving the real experts – that is, patients, health providers and other key constituencies – generally leads to the most relevant and innovative approaches. Ideas generated from structured brainstorming invariably lead to actionable opportunities to create experiences that matter because they’ve been created by the very people they’re intended to serve.
Steve Jobs famously said that design is not what it looks like, but how it works. Human-centered design offers a process to ensure that health care is intentionally designed – from the outset – with the people it’s meant to influence and support from the start.