heuristics

UX Workshop at #HIC18

HIC 2018 is in Sydney this year and this year I had the pleasure of going to the UX workshop that was held pre-conference. I particularly enjoyed the perspectives given by Bennett Lauber - The Chief Experience Officer at The Usability People (USA) and the workshop on co-design facilitated by Dr Emma Blomkamp and Dr Chris Marmo of Melbourne design consultancy PaperGiant. 

The Importance of Co-design

Telehealth is one of those things in healthcare which is often met with groans and resistance from clinicians due to many failed attempts to launch such initiatives. As such, the failure rate has been very high. Karrie Long of The Royal Melbourne Hospital provided a presentation as to how RMH used co-design principles to create a user centric telehealth platform that addressed user's pain points. Karrie showed us a picture of this entrance at RMH which is one example of extreme poor UX, how can anyone work out what is going on in this picture? The thinking with showing us this front door was that the team needed to create a digital front door experience that was easy and simple to use.

When you need signs in health you know that the UX is not functional....

When you need signs in health you know that the UX is not functional....

Considering the experiences that patients have at the RMH with wayfinding being such a pain, the team created a digital front door for telehealth that was simple and straightforward. This is extracted from the RMH Website. 

Credit: https://www.thermh.org.au/telehealth

Credit: https://www.thermh.org.au/telehealth

A simple interface for users to click directly to engage with their clinician whilst the administrative staff configures the access points to enable patients to attend their digital consult in a straightforward manner, encourages a positive patient experience and changes the negative attitudes to telehealth.

PaperGiant facilitated a workshop on the principles of co-design, which was interesting and very relevant to the work that is completed in healthcare. The facilitators walked us through a case study, looking at the questions that we need to ask to extract the core information that the client may want. For example, the client may THINK that they want a certain solution for their problem but in actual fact, what they are looking for is that they want to solve a problem - the method as to how this is achieved is irrelevant because this can be elucidated through your user research. 

Full credit to papergiant.net. This tool was provided to workshop participants.

Full credit to papergiant.net. This tool was provided to workshop participants.

Usability x UX

The UX talk that challenged my thinking the most was Bennett Lauber's talk on usability. It was interesting to see the health system from an international perspective, in this case the UX and the various political agendas that have influenced the climate of digital health over there. The US has a much more mature model for hospitals that have EMRAM Level 6/7 (EMR Adoption Model) whereas in Australia, we are miles behind. Bennett emphasised the importance for conducting your user research through methods such as persona mapping (as I have blogged about previously) and surveys to really get to understanding the user's needs. And as a tip, Bennett noted that Contextual Enquiries, which is basically going to the client's context and understanding the things that they do, if there are workarounds or other pain points, to really see the impact of how the things we design impact the workflows for our clinicians. 

The thing that was most interesting for me was the 'myth of fewer clicks'. As a widespread belief, the fewer clicks it takes to achieve the user's objectives, the better it is. Bennett challenged this notion, by stating that perhaps in healthcare what we want isn't just fewer clicks, but instead at times we need to force the users to go through more clicks so that we can mitigate risk and attain better health data. This really made me think. Sometimes we need to burden our users to get better and more accurate healthcare data so that we can understand the larger trends that emerge. If we simplify the system too much, the richness of the data or the potential to attain that level of acuity of data might be missed.

Furthermore, users of the system can quickly turn from novice to intermediate users rather quickly. So as to why some healthcare software systems are deliberately complex, it is to enable the intermediate to expert users to have the ability to customise their user flows. What was striking to me was Bennetts comment that novice vs. an experienced user will interact with the software differently, perhaps simplifying software really isn't the agenda after all.... Definite food for thought. 

In a previous post, I mentioned Nielsen's Heuristics. Well, guess what? There are healthcare specific heuristics!!!! You can find the Nielsen-Shneiderman Heuristics HERE

How do we get our organisations to talk more about UX?

UX's value lies in the ROI for an organisation. The short term gains for investing in UX are not highly visible in many healthcare organisations. In a constrained funding environment with many competing priorities, there is no doubt that resources should be used to address patient issues. But considering poor UX in healthcare software, with a poorly designed experience, this creates the need for training the trainer and training the users, which is a high cost for organisations. Perhaps it is important to indicate to organisations that UX investment in the healthcare space has potential to reduce lost hours spent in training rooms and therefore, leave enough time for clinicians to care more for patients. And to that effect, with poor UX in healthcare software, risks may be prevalent for example, having interfaces that have too much cognitive load and thus, confusing the user and creating chaos..... 

Heuristics in Healthcare Software (or lack thereof)

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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. 

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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?