Design has had a massive impact on the success of many organizations, especially tech companies. However, there are still plenty of sectors where design doesn’t have a seat at the table yet. Healthcare is one of them.
In healthcare, change isn’t embraced as much as in other industries. It comes more slowly, partly because it can have serious implications on the health of millions of people, and the user experience in some areas hasn’t changed in decades. Healthcare products also have the tendency to be very technical and scientific, and often don’t take the people interacting with systems or processes into account enough, from doctors to nurses to patients. Then there are privacy issues, and questions around how data is handled and what recommendations and insights a user can receive. As a result, doctors are spending a lot less time with patients and more time battling inefficient medical systems.
“It’s an honour to work on products that can improve the lives and outcomes of patients facing some of the most difficult times in their lives,” points out Barbara Spanton, senior manager for user experience at Varian Medical Systems. “But the reality of working on these deeply impactful products is full of obstacles. This work often exists in sensitive domains, which are slow, regulated, and involve all the legacy and integration baggage you might imagine.”
Despite the challenges, there are also huge opportunities in designing for this highly-specialized domain. A better user experience is urgently needed. In an ideal scenario it can save lives. But it’s also needed because some significant change is happening: health is no longer confined to the walls of the doctor’s office. The web has empowered people to manage their health themselves more than ever before, making it critical to get the UX of digital health products right.
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“Healthcare is an incredibly competitive and fast-moving sector,” says Andy Thornton, design strategy consultant at user experience design consultancy Clearleft. “The ability to take advantage of emerging technology and create services and user experiences of exemplary quality is crucial for adoption and retention of users, more so than perhaps in any other sector right now.”
For this article, we talked to some of the world’s leading designers and thought leaders in the field who are actively working on making a difference in healthcare UX. They cover both the challenges and the opportunities of designing for medical care, and explain how UX design can benefit a space where it’s traditionally been lacking.
Design with empathy for the users from the start
One of the biggest challenges of designing digital products for healthcare is also one of the most obvious ones.
“You can’t ‘move fast and break’ things when the product you’re building really does have life or death implications for those who will use it,” points out Jonny Belding, partner of digital health design agency Hanno, which hosts a weekly podcast on building digital products for better health and wellness. “Our team didn’t always work in the health space. In a previous life, we did a lot of work with non-medical startups, so our journey to becoming digital health designers has been a real eye-opener.”
Healthcare is a space with heightened sensitivity, which means you need to carefully consider privacy, ethics, and laws to conduct your research. The design process itself, however, still starts and ends with customer insight.
UX pioneer Don Norman adds that UX mistakes you tend to find in other sectors could have far more damaging consequences in healthcare.
“I just spent 15 minutes trying to log on to a certain airline’s website, for example,” he explains. “I assumed I had the wrong password, but each time I use the new password they suggest, I get a 403: Forbidden error. My experience with the system over the past several months has been so bad that I simply will never fly with them again. But what if this had been a critical medical device? The patient might die while I tried to figure out what I could do. I couldn’t simply refuse to use the machine.”
This gravity of what’s at stake means that the journey to launching a product in the healthcare space can have many more hurdles than you might see elsewhere. You simply can’t apply many of the approaches and techniques you’ve learned because they’re not intended for highly regulated industries.
Understand the bureaucracy and regulations
Apart from legacy technology and siloed practices, one of the biggest hurdles in designing for healthcare is the bureaucracy and regulations involved. These impose severe constraints, high costs, and a lot of delays.
“Regulation can significantly affect the quality of the experience you're able to deliver,” cautions Clearleft’s Andy Thornton. “Also, regulatory standards in healthcare can vary hugely from region to region, making consistency and scalability of design solutions problematic.”
It’s therefore not unusual for designers in the healthcare sector to have years of work still going through studies and trials before it eventually gets regulatory approval and reaches the market.
Barbara Spanton focuses on a different persistent challenge. The digital products she works on are Electronic Medical Records (EMRs) – sometimes also called Electronic Health Records (EHR) – essentially digital versions of the paper file(s) that a doctor keeps as a record of a patient’s health data and events. EMRs impose a heavy burden of increased complexity on clinicians, without reciprocating any perceivable benefit.
“The promise of digital EMRs is the smart use of previously-entered data to find insights, streamline and optimize care,” Barbara explains. “They also promise real-time safety checks and mitigations to ensure patient risk is minimized, easy sharing of patient data across hospitals and clinics, and increased efficiency in capturing and accessing records wherever and however you need them. However, this promise remains undelivered. Clinicians are spending additional hours every day documenting through dozens of controls, forms, and workspaces [the same information that] they used to be able to capture in a few short phrases on a paper chart. These systems benefit medical processes, hospital administrators, and claims. But they’re often an obstacle to delivering good care by patient-facing users.”
Barbara believes that these challenges can be overcome by establishing a UX team that’s well-connected both within the organization as well as with end-users. She suggests framing all product decisions in terms of the impact they will have on all players they touch – be it the patient, clinician, caregiver, or administrators, and prioritizing the specific roles or scenarios that a specific product or feature must serve.
Collaborate with non-technologists
Collaboration is crucial in order to create an effective digital product in healthcare.
“One of the big challenges in healthcare is to keep things simple,” finds Daniel Burka, director of product and design at Resolve to Save Lives, which is currently working on Simple, an app that helps improve hypertension control. “Health involves a complex, deeply interconnected web of systems and roles. How can we make tools that embrace that complexity yet are easy to use? It’s crucial that clinicians can focus more on their patients and less on data systems. To succeed, designers need to collaborate with everyone involved in delivering care. Your job is part-time designer and full-time facilitator.”
Andy Thornton adds that designers need to understand the multitude of touchpoints that are intrinsic to healthcare.
“Just in terms of the primary care experience of patients, there’s symptom identification, appointments and consultations, diagnosis, and prescription,” he points out. “They all have a variety of online and offline integrations to be considered. It’s a complex space with a diverse range of user needs. Understanding this complexity, and that not everything can be easily ‘automated,’ is key to designing appropriate digital solutions.”
Don Norman agrees and cautions that many developers seek the advice of physicians, not realizing that the bulk of patient monitoring and supervision is performed by nurses, making them the real experts of the needs and quirks of medical devices.
To collaborate effectively, Stacy La, who’s currently leading product development and design on the Resolve to Save Lives’ Prevent Epidemics initiative, suggests humbling yourself and keeping your ego in check.
“Too often, the creators of digital products think they will solve all of healthcare’s problems,” she explains. “But technology by itself is not the solution.” For Stacy, improving the user experience of digital products in healthcare requires technologists to first, understand the healthcare ecosystem and its regulatory environment. Second, they need to have empathy for the people delivering and receiving healthcare services. Third, developers need to include healthcare providers in the design process.
Stacy also advises not to get discouraged from working with non-technologists. In fact, these professionals’ rich experience and insights can help improve your team and your product.
“Use it as an opportunity to share with others the power of design to make better products and deliver better services,” she recommends. “Designers have the ability to synthesize and visualize. We can distill complex workflows, processes, and ideas to get people on the same page. We can break down silos by showing people where inefficiencies are, and facilitate conversations that lead to solutions. This allows us to have a huge impact, even though healthcare isn’t a sexy industry.”
Human-centred design in an extraordinary context
In healthcare, established UX methods and practices are still applicable. Yet designers need to understand these new environments through contextual research.
“Everything I do is based on human-centred design principles,” explains Tim Caynes, experience design director at Foolproof, who over the last few years has been collaborating with a provider of cloud-based visualisation software for endovascular surgery. “The most basic articulation of what that means is – I try to understand people to make better things,” he clarifies.
“During my research, I’ve had to learn a whole set of languages, contexts, services, and ecosystems, to really understand the motivations and behaviors of clinicians with a singular focus – improving the patient experience,” Tim says.
The design process therefore included interviews with surgeons and observations in the operating theatre, to really understand what they do in their own context. This knowledge helped the team make better decisions about how they approach the design.
“We also discovered a couple of things about surgeons that were really important,” Tim reveals. “They are very short on time, and they’re highly focused. So in order to facilitate a meaningful conversation and not waste their time, it was critical to establish a level of trust between us and them, and that meant demonstrating knowledge and understanding of their areas of specialty. I’m 100 percent sure we would have not got to the same level of detail and engagement, if we had simply turned up without acquiring the depth of knowledge we did.”
Conduct extensive user research
Healthcare products span an enormous rage. As a result, designers must not only understand the clinicians’ needs and frustrations, but also consider the interests and motivations of various other parties, especially the patients’.
Working in healthcare is incredibly rewarding and fulfilling. It drives you to do your best, knowing that your work is helping people at some of the most difficult times in their lives.
Hanno’s Jonny Belding highlights the importance of conducting extensive user research, especially as the type of problems you’re solving don’t necessarily have immediately obvious solutions (for example, helping a parent to manage their child’s type 1 diabetes or building AI to help doctors diagnose cardiac diseases faster).
“While user research is a crucial part of the design process in any industry, the user needs – and physical and emotional context – of a person managing a medical condition can be a lot more complex than those of your typical ride hailing app user,” he explains. “That means that a lot more user research is needed to get to the heart of the problem and understand it from both a medical and behavioural perspective, before we can design an elegant solution.”
Healthcare is a space with heightened sensitivity, which means you need to carefully consider privacy, ethics, and laws to conduct your research. The design process itself, however, still starts and ends with customer insight. For more on this see Google’s UX Playbook for Healthcare, which covers UX research from end-to-end and includes a collection of best practice tips designers can follow to guide and delight users and establish trust.
“Inform your design decisions from a deep understanding of the people using your services before co-designing and testing your solutions with them,” Andy Thornton advises. He notes that good design research and the scientific method actually have a lot in common. “Good research is led by observation and asking questions to form measurable hypotheses,” he says of both science and design. “These hypotheses are then tested, analysed, and interpreted to inform an improved iteration of the solution. It’s no coincidence that stakeholders can easily get on board to this approach.”
As an example, he points to products that he’s been involved in at Clearleft, which aimed to reduce the demand on primary care providers, or at the very least to use them more appropriately.
“The biggest challenge in helping the public become more proactive and preemptive in their approach to their health and wellbeing is changing ingrained behaviors,” Andy explains. “Moving from a state of ‘I have a heart condition and need to take medication’ to ‘I have high cholesterol and need to be reminded to exercise more’.”
Good human-centered research is one way to ensure you are tackling potentially hidden underlying needs. Andy suggests techniques such as the five whys to help you get to the bottom of root-cause problems. He recommends Don Norman’s seminal book The Design of Everyday Things, which covers this notion in more detail, as in this quote:
“People don’t want to buy a quarter-inch drill. They want a quarter-inch hole. [...] Once you realise that they don’t really want the drill, you realise that perhaps they don’t really want the hole either: they want to install their bookshelves. Why not develop methods that don’t require holes? Or perhaps books that don’t require bookshelves. (Yes, I know: e-books)”
Last year, Clearleft set their interns the challenge of helping the British National Health Service (NHS) “do more with less”. They were astounded to learn that a third of people each year admit to seeing a doctor for a minor condition that they could have treated at home. Through research they discovered that anxiety, lack of confidence, and forgetfulness ‘got in the way’ of self-care; people were simply giving up too early, and too easily – a fascinating and underserved design problem.
The result of the three-month project is Self Treat, a vision piece designed to increase self-management of minor health conditions:
Better products with realistic strategies, determination and optimism
Working in healthcare is incredibly rewarding and fulfilling. It drives you to do your best, knowing that your work is helping people at some of the most difficult times in their lives.
To effectively tackle the many challenges in this field, Barbara Spanton believes that “we need to move beyond this idealistic notion of ‘doing meaningful work’, and settle into the reality of having impact in these often complex domains. We need strategies to help break down obstacles, stay motivated, and have impact in the long run. And we need to find a source of optimism and determination to fuel us through this slow, difficult work.”
While Jonny Belding acknowledges that healthcare work comes with a lot more restrictions than most industries, his team has found these don’t mean you can’t create engaging experiences. There’s a lot of room for innovation.
“You can still put what matters to users at the heart of the product,” he encourages. “You just have to be willing to break the mould and find new ways to blend science, art, design and engineering to support people in- and outside of the clinic. For designers, that’s hugely satisfying.”
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