Adopting UCD in healthcare

So previous posts on exploring user-centred design (part 1) (part 2) have been laying the groundwork for us to think about whether this way of designing products is the best approach for healthcare. I put this question to Jonathan West;

Do the aims of user centred design make it the best model to follow for health care?

“A good question to ask is what would the other option would be?”

West asks a sensible question, in regard to health care it would seem that surely all design should be and will be classed as user-centred? Given the sole focus of the entire health care system being to provide care and medical support to patients through clinical professionals, there could be no other constraints placed on projects. However it is apparent that the aims of user-centred design are not being achieved within health care settings. With over 8 years of experience designing for health care and much time spent in hospital wards, West gives a telling example regarding peristaltic infusion pumps.

“The designs in and of themselves aren’t bad, but the interfaces are all different, with different pumps on each ward. Keying in numeric rates use a ‘numpad’, some pads go from top to bottom, some go bottom to top!”

West went on to explain that the most common failure he sees with this equipment is a patient receiving either 7 times too high a dosage or 7 times too little, he explains that with scientists and technologists designing the equipment, human factors are not considered. The following images ( Fig 1 & 2 ) highlights the area of confusion, the similarity in the appearance of the number 7 and 1 who then regularly swap places on the same piece of equipment within a hospital.

Of course this problem only occurs in context, when two functionally similar objects are designed with opposing interfaces and are then used alongside each other. It could therefore be argued that there was no way of avoiding such a difference. It does appear however that human-centred research into how the products are used, the patterns of behaviour exhibited by the Nurses using the infusion pumps and the analysis of designing out medical error that has already occurred. This approach is backed up by the Designing out Medical Error report and designs, (Anderson, Davey, & West, 2011). Based on the design research and outcomes produced, it would appear that design solutions could be used to resolve such issues.

As established in the previous posts, this human-centred research is an underpinning factor for user-centred design and could in this case lead to saving lives. It quickly appears that designers who approach a problem with user-centred aims, who deliver designs and solutions that are backed by extensive human-centred research should have the tools to solve complex medical problems. So why is this not already the case?

“Everyone says they use user centred design – But the evidence is that errors are still happening within hospitals with their designs”

Medical Error

When considering this seeming lapse within the design community it would be appropriate to consider briefly the existence of medical error within hospitals. Defined as “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim” (Kohn, 1999), Medical error does not always end in adverse effects (Kohn, 1999) (Williams, 2007) but highlights a weakness in the health care system, to which a design could respond. It is very much worth noting that design to eliminate errors within health care is not the only arena with which product designers should concern themselves with, there is a vast array of products requiring design that may never see the ‘front-line’ of usage within hospitals, although being of no less value here we will deal with those seeing the most drastic evidence of poor design, ultimately with the possibility of life and death mistakes.

There are limited statistics documenting the scale of medical errors, most likely due to the sensitivity of the issue, but two are cited in ‘To err is human’ which is then considered in ‘Design for patient Safety’.

“Two large studies, one conducted in Colorado and Utah and the other in New York, found that adverse events occurred in 2.9 and 3.7 percent of hospitalizations, respectively” (Kohn, 1999)

The idea portrayed here through language such as ‘embed’ imply a strong sense of the designer finishing a product, applying the meaning (whether aesthetic or semiotic) to an already existing functional object, not a comprehensive role for the designer in developing the product from the outset. This bears striking similarity to the focus-group driven, aesthetically minded ‘old model’ suggested by laurel.

It should also be noted that this does not appear to include those errors that do not lead to ‘adverse events’. From these studies, if the figures are extrapolated to account for all 33.6 million hospital admissions in the U.S. during 1997, the Colorado and Utah study implies that at least 44,000 Americans die each year as a result of medical errors. The New York Study suggests the number could be as high as 98,000. Even considering the lower estimate of 44,000, deaths due to medical errors exceed the number of deaths from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516).