Personas and User Journeys in Health

The health system is so complex and every day on the wards, you're bound to meet someone from a completely different background than you are. As healthcare professionals, because we meet so many people, empathy is such an essential element in our practice. I love the principles of UX because it alludes strongly to designing things with empathy, to ensure that we cater for all the populations that filter in and out of the health system. 

Creating our personas from UX research is an amazing way to truly gain insights into the predicaments of our users. Using these persona's and then mapping out their journey to accomplish specific tasks is a powerful way to look at the real pain points and using those pain points to create solutions that can be as simple or as complex as you want. A lot of the times we don't realise that these are the problems our users face until we are empathetic of their journey and then we can truly feel what they feel when using our services.

The health system is full of different users and the personas are aplenty. You have your patients that are either coming through ED, are a planned patient, long stay, short stay, young or old. With such a variety of patients that come through the system, a one size fits all approach to our user's problems will not work. What may work intuitively for some patients i.e. those who are technologically competent and then designing all our interfaces to be primarily digital interfaces will exclude those that are not competent with technology. It is through the development of our personas that we can understand thoroughly of the smaller things that we can implement to improve the patient experience.

Let's take 2 separate visits to hospital and you will have:

  • Sally Ryan - 33 year old mother to 3 year old Chloe, who is bringing Chloe in because she is worried about Chloe's temperature and she isn't playing as much
  • Heather Franklin - 83 year old admitted with an exacerbation of COPD 

Sally's Persona and User Journey may look a little something like this...

Sally Ryan's user journey through ED

Sally Ryan's user journey through ED

Heather's Persona and her User Journey might look a little something like this

Heather's user journey throughout her hospital stay

Heather's user journey throughout her hospital stay

It is apparent that Sally and Heather's user journeys are markedly different and here in, they have different requirements and pain points. Henceforth, we need to design an experience that caters for what these two users of our health system need. Perhaps if we understand if Sally is a hypochondriac (or not), maybe we can provide parents with young children with information via their predominant behaviours such as their usage of social media. Maybe in Sally's case we can simply orientate these patients to their surroundings a bit better and have procedures which remind our clinicians to notify their next of kins of their situations in a more timely fashion. Sometimes the tweaks to user experience don't necessarily have to be rooted in technological solutions. In fact, it is through mapping our user's journeys and understanding their pain points that we can find areas to improve upon. There's so much to be done and that is exciting!

Heuristics in Healthcare Software (or lack thereof)


Ever since I have delved into thinking more and more about software design in healthcare, I always have flashbacks to my days as a junior clinician when I first encountered the health system. I recall the first time I ever picked up a friend's iPhone and was immediately taken aback by how intuitive the design was. Clicking into a button did exactly what I wanted it to do, the symbols such as the search button, the home button and all that were frankly, quite similar and familiar already. Learning how to use an iPhone was easy-peasy. 

Nielsen's Heuristics are considered the general principles in user interface design and when looking at his list of principles to consider when designing software products, it's all quite intuitive and makes sense. These are:

  1. Visibility of system status - i.e. if the page is loading, there should be a loading bar
  2. There is a match between the real world and the online world i.e. calendar icon looking like a calendar - this helps with familiarity and learning
  3. User control and freedom - the user needs to have the freedom to 'undo' an action that was unintended
  4. Consistency - you shouldn't have to reinvent the wheel, given the plethora of mobile apps these days, there are some design patterns that can be replicated and these are more often than not, familiar to the user
  5. Error prevention - remember those days when you say in your emails 'please see attached' and you forget to actually attach the file? well, outlook and gmail reminds you to do so when they detect you typed the keyword 'attach' and haven't actually attached a file - that's preventing an embarrassing error!
  6. Recognition over recall - it's like google predictive search.... 
  7. Flexibility of use - have different options for basic vs advanced users
  8. AESTHETIC AND MINIMALIST DESIGN - need I say more? no.
  9. Help users recognise and recover from errors i.e. uh-oh sorry the password doesn't meet standard etc
  10. Help and documentation - have accessible help for users to navigate to.

Nielsen's heuristics are rather intuitive and logical, I definitely believe that these principles should be underlying any software that is developed for users. 

Anyway, coming back to my clinical days, I recall having to attend training to use this piece of software and thinking how absolutely ridiculous that sounded. I had always considered myself as a proficient user of new software because eventually, I would be able to stumble my way through the software and achieve what I wanted. I was always the type to reverse engineer things so that I could find my steps back. Little did I know that this would be a hallmark for how well designed that software was because if it was really well designed, you wouldn't need to actually attend a class for it. Imagine going into an organisation and no longer needing to attend any training for using basic software - it would save a lot of time and money. I digress. 


An example of healthcare software

Please stop, my brain hurts!

I decided to actually draw the piece of software that I would use in my clinical days. Please excuse my messy writing but honestly, this is such a cognitive overload! There are multiple task-bars at the top, which already is overwhelming for the user and violating any terms of minimalist and aesthetic design. Already as you open the tabs, there are multiple windows in the same area, trying to communicate vital medical information. It's not well depicted in my picture, but I remember that there were multiple ways to navigate the interface to find the same information. Some of frustrations that I had were:

  • Not being able to find things quickly
  • Needing to sift through different consult notes by expanding each note and then needing to collapse it
  • Feeling overwhelmed by the amount of clinical data on the one page 
  • Not knowing how to do some things, because the action was hidden under another tab. Finding that tab had to be taught to me by an experienced user.

Thinking back, I learnt how to use this programme over time because I had to, but thinking it from a UX point of view, there are a multitude of pain points that are risky for clinical care.

But the biggest risk factor that I can identify would be Cognitive overload - not being able to locate the proper information can lead to errors in patient care. In such a high risk environment, delivering the correct information at the right time when clicked in the right area should be a priority. Providing clinicians with the correct information in a dashboard that doesn't dumb down the information nor complicate it, will allow them to make quick judgements and create a more integrated seamless environment for connectivity to the internet of things. The future is endless with possibilities for achieving amazing patient outcomes, let's start with design, shall we?

Umm, hello, where is ICU?

In my clinical and my current career, I've worked in many different hospitals in the capacity as a clinician, in an administrative role or as a student. In all situations, I've had to become familiar with navigating the hospital and to me by far the easiest hospitals for wayfinding have to be either:

  • Royal North Shore Hospital
  • Gold Coast University Hospital

I will not name and shame those ones that are absolutely notoriously difficult to get around, I have my reservations on that. But this is another aspect of user experience or in this case, patient experience that I hadn't consciously been aware of until I started thinking about the many different things that patients experience in the hospital.

The patient journey within the hospital can be digested into a user journey map - there are so many different persons that walk into our doors, but for an easy overview we'll class them in terms of their ages and their status - they're either an outpatient, an emergency acute patient or a pre-planned patient. Therein itself creates a multitude of personas that who each have unique demands of their own. Anyway, I digress, there's a lot I can talk about in UX within healthcare, but I'll save that for another time. Back to the subject matter - wayfinding in hospitals is one thing that patients, families and even clinicians have to face on a daily basis. In the hospital I worked in as a clinician, knowing my way around took up to a month - it gets easier knowing the nooks and crannies when you have been there for a month but not when you're there for the first time.

I can attest the fact that walking into a hospital with confusing signs and wards that sound extremely similar is overwhelming for families visiting the hospital. It isn't the patients that will usually be the ones wayfinding but its the visitors who will be. Coupled with them having the stressors of loved ones being in hospital, the experience of walking into a hospital that looks sterile, institutionalised and difficult to get around is an issue that isn't ideal.

The designs of Royal North Shore Hospital and Gold Coast University Hospital are two examples that I'd like to highlight that focuses on the user experience.

Navigation around RNSH's new building is relatively easy. The user walks into the front entrance that is designed like a shopping mall, with food court areas, coffee carts and small retail shops lining the amphitheatre, creating a space that is removed from the traditional sterile hospital feel. But the highlight isn't about the shopping mall area but it is the success in the wayfinding experience.



The exterior of RNSH is colour-coded into yellow, orange and green. 

The exterior of RNSH is colour-coded into yellow, orange and green - which definitely earmarks the yellow area of the building, orange and so forth. Correspondingly, as visitors walk into the front entrance of RNSH they are met with...


Lifts with Colour Coded Signs

The true innovation is distilled here in this image shown above - as visitors walk in they find the ward they need to go to and are directed to the level and the relevant colour coded lift to visit the right ward. So for going to ICU - take the yellow lift to level 4, genius.

This creates a seamless and integrated experience that accounts for the complexity of a large tertiary hospital yet user friendly enough that it promotes visitor autonomy and flexibility to navigate the hospital with ease. Colour is simple and translatable to all types of user personas that will interact with this environment and it is an effective solution to create ease of wayfinding. Moving forward with new builds happening around in health, distilling to what the user's needs are in terms of the simplest of experiences such as wayfinding will alleviate pain points in their interactions with health care.

Week 6 of UX

I won't pretend to claim that I know much about UX as I only started delving into this subject area last month. I am definitely a novice and the more I read, the more I realise that there is so much to learn in the area of UX. I feel somewhat overwhelmed at how influential UX is in terms of all facets of the design journey. 

As a person who works on the management side of health, improving patient care outcomes has always been at the forefront of my mind. The organisations I have worked for have placed immense focus on measurable KPIs and thus, this had been my initial frame of reference. In the first two weeks of my UX class, we were taught how to write How Might We statements.

How Might We statements are purposed to frame problem statements into design opportunities. It elicits empathy from the UX designer, to turn the problem into something that can assist with alleviating user pain points. My initial How Might We statements were absolutely hopeless, they were:

  • how might we improve patient flow within the emergency department?
  • how might we improve patient flow within the hospital to decrease wait time?

These statements, although they do have an edge of thinking about the patient i.e. decreasing wait time, were absolutely wrong. I didn't even realise that I was subconsciously putting the business' goals into my how might we statement, detracting any focus on the user... No wonder I just didn't get it. It wasn't until the next few weeks that I could finally break the preconception of focussing on business needs and actually incorporate the user's needs. My how might we's eventually improved...

  • how might we better understand patients needs on discharge so that we can help them feel more satisfied with their care?
  • how might we decrease the time patients spend in hospital to ensure that they are satisfied with their care?

The shift in the tone was evident, I was finally able to create questions to begin my user research... 

Healthcare and UX at Academy Xi

I started my UX course at Academy Xi last month and I feel as if I will be documenting the journey here because it will be interesting to see how much I have learnt.

The main impetus for applying for a $3500 AUD course was quite simple down to a few things:

  • A few life things had happened and thus, I had some time to myself 
  • Through this whole process, I've gained more perspective and now I am much more focussed in my career. I want to be innovative and forward thinking
  • Because learning a technical skill is invaluable

But the biggest factor was basically I started to realise how there were so many projects in health that have a digital element. Interfaces were becoming digital and inherently, I can see a major factor of risk. Health is notorious for having poorly designed and counter-intuitive interfaces that makes a crappy app store app look genius. I can't begin to fathom why clinicians keep putting up with horribly designed programmes that have poor usability and I think the poor design can often lead to mistakes. And the Swiss cheese model takes over here, where a multitude of tiny issues can ultimately lead to a catastrophic failure. Due to the fact that the user experience component is hardly ever thought of in health, I thought it would be perfect to understand the framework behind this thought process and combine it with health. 

My first class at Academy Xi was great and I felt like I was finally tapping into the creative side of my brain that I never really thought I had. My class has 11/14 graphic designers, so most people are creative. What I enjoy about UX is that it isn't simply about your ability to draw great things, but it is the embodiment of human factors, functionality, elegance and aesthetic to deliver an experience that caters to the user's requirements. We were thrown into doing a rapid prototyping/ideation exercise that stretched the limits of my creative thought process. What truly amazed me was how effective it was to use these constructs to deliver a viable and workable solution. It was a great way to be thrown into a foreign world of UX and I can definitely see that there is a relevance of UX in my job/career. I'm super excited to incorporate the things I learn into this course.

This is the beginning of a new journey. It's full of so much opportunity.