Hospitals are complex ecosystems. Few service experiences have the potential to involve so many different people, or to have such dire consequences when something goes wrong. Throughout the last few decades, technology has rapidly been developed to help support these ecosystems and the many people involved.
On one floor, a team of doctors and nurses perform delicate surgery, checking monitors to ensure everything is going according to plan and the patient is stable. One floor up, executives convene to discuss finances, reviewing data on their patient populations to ensure their initiatives are having positive impact on the hospital’s quality of care, and in return on their bottom line. Throughout the hospital, patients and their loved ones wait anxiously to get checked out, to hear results, to have an operation, or to be discharged. While there are many different types of users within the hospital ecosystem, through our projects and first-person research we’ve seen there are three primary groups that define the vast majority of the users for hospital systems: patients, administrators, and practitioners.
The mindset of patients is fundamentally different from both administrators and practitioners, as they’re consumers of the service rather than providers. Since they’re at the hospital, they’re likely also substantially more anxious, scared, in pain, or otherwise not in their ideal state.
Our adoption/completion rate is over 90% which is unheard of in digital health. The key to our strategy is to take a complex topic and provide a simple, streamlined user experience.
– David Cerino, CEO of WiserCare
Technology products that involve patients often include scheduling tools, waiting room displays, and information systems that help them understand their condition and treatment, which may be utilized alongside a practitioner at the hospital or elsewhere, either in preparation for their visit or afterward.
For basic logistics tools, such as those focused on scheduling and waiting room management, patients’ goals are focused primarily on efficiency. Nobody wants to spend a substantial amount of time filling out forms, whether digital or paper, or trying to figure out a new system just to make an appointment. Patients want to get their information in quickly and simply, and easily understand their current status — will they be waiting 5 minutes, or 2 hours?
Patients today have not only more information available to them, but also more data about themselves to bring to practitioners. Activity trackers, food and sleep logs, and tools providing genetic data all provide a wealth of health-relevant information that can factor into patient care. Through systems provided by hospitals, as well as third party systems, patients now can keep track of their Personal Health Records (PHRs) and provide robust histories to healthcare providers. While many patients now have this data, they’re not always sure what to do with it, or if and how their provider might utilize it.
Beyond personal health data, the internet makes a seemingly infinite amount of information — of varying levels of validity — available to patients about symptoms, diagnoses, and treatments. As patients have greater visibility into the healthcare space, many desire to have more control over their health, especially where multiple treatment options exist. As a result, many practitioners are looking to adopt patient-centered decision processes, combining their expertise with medical evidence and patient preferences. In work with WiserCare, a healthcare startup helping patients make informed decisions about their health, we’ve seen that patients are eager to take their health into their own hands, making treatment decisions that reflect what best fits their personal values and preferences. “The more engaged a patient and their family is in making treatment decisions with their physician, the more likely they are to adhere to the treatment, which results in better outcomes. Better outcomes, combined with higher patient satisfaction and loyalty, are a win-win for health systems, their clinical teams, and, most of all, the patient,” said David Cerino, CEO of WiserCare. He continued, “At WiserCare, we are especially proud of how patients have engaged with our tool. Our adoption/completion rate is over 90%, which is unheard of in digital health. The key to our strategy is to take a complex topic and provide a simple, streamlined user experience.”
What to know when creating products for patients
Medical jargon is confusing, and will turn away users who feel like the content is over their head. Use familiar language and explain unfamiliar terms they’re likely to encounter. Utilize visuals wherever possible, as they may be more quickly understood than text alone. Ensure the tone of all language is both knowledgeable and supportive; friendly, but not overbearing.
With information tools, which help inform patients on what to expect or what their current status is, clarity and comfort are key. Health is a sensitive topic, and while no technology is a substitute for quality in-person care, a system that presents information in familiar terms with a tone appropriate for sensitive health information can provide clear value before and after a patient’s visit.
Hospital administrators, which include C-suite executives as well as non-practitioner management at various levels throughout the organization, are responsible for ensuring that the hospital is providing quality care with cost and resource efficiency. In the U.S., administrators are guiding their organizations through the evolving healthcare and insurance landscape, including value-based care and Accountable Care Organizations (ACO). Shifts toward population-based health have changed how providers track and manage performance, as well as how they approach initiatives to impact performance. Complex cost-sharing structures are providing benefits to both providers and insurers, but they increase the need for administrators to keep a close eye on patient outcomes, which are increasingly tied directly to financial incentives.
Administrators, like upper management we’ve seen in other industries, need to understand what’s happening, what it means, and what can be done to change it as quickly and easily as possible. In a population-based health model, they need to be able to see what’s happening within each defined population (such as patients over 55 years of age who have heart disease), and understand why outcomes within a population are better or worse than expected. They need to be able to easily take this information and share it with other administrators, to help make strategic decisions, and with practitioner leaders to help develop and track initiatives to improve performance. Through our research and design work with GE Healthcare, we’ve seen an increasing sophistication not only in the products available to administrators, but also in administrators’ ability and desire to integrate big data into their organizations to gain deeper understanding and insights into performance across departments, individual practitioners, and the hospital as a whole.
What to know when creating products for administrators
While administrators are often looking broadly at what’s happening throughout the hospital and within patient populations, administrators want to be able to drill-down as needed. Managing data scope and providing simple tools for zooming in or out to different levels of granularity is essential in products used by hospital administrators. While having easy ways to zoom in and out are essential, products for administrators will be most powerful when they make problem areas, or areas of unexpected success, immediately apparent. Rather than the administrator needing to dig out problems, problems should be pushed to the administrator so he or she can create action plans as quickly as possible.
Though opinions have been changing in recent years, doctors and nurses are historically among the least excited to implement new technology products within the organization — and for good reason. For many years, software in the healthcare space lagged in usability and design behind tools in the consumer space, as well as in other verticals. Unlike in many other industries, practitioners in hospitals desire high information density. In many cases, systems are set up on mobile carts within the hospital (we’ve heard practitioners refer to these as “COWs,” or computers on wheels), designed for quick use between other tasks. Products in these contexts should rely on information that is dense, but well designed, ensuring a clear hierarchy and priority of information and clean, easily legible displays. In the past, many products required too much digging around or used complex, confusing workflows, making them undesirable to busy practitioners.
Practitioners have typically spent a significant amount of time learning and honing their approach to patient care, and are resistant to change. In our work with Zynx, a leading provider of evidence-based clinical decision support tools, we learned that younger practitioners are often more accepting of the type of technology used in hospitals today, including Electronic Health Record (EHR) systems and order sets (a form of clinical design support tool), as those were part of their education and always a part of their approach. Most practitioners, whether doctors, nurses, or lab techs, are highly disciplined with specific, repeatable processes they’ve honed over the years. Often, this can mean chunking behaviors into small slices of time that are repeated continuously — a radiology technician reviewing X-rays, for instance, might spend a few minutes reviewing images from a single patient, using a standard set of steps to open and review each image, before moving to the next patient and starting again. Products in this space are generally most beneficial when supporting these types of behaviors, making them more efficient, more effective, and/or safer.
Regardless of their level of experience, we’ve seen that practitioners are people with a strong drive, necessary for working the long, stressful hours demanded of them. Many practitioners are highly competitive, and possess a desire to perform well compared to their cohort. Utilizing healthy competition can provide a motivating factor within a product, as well motivation for frequent, continued use to keep track of competitive performance.
Finally, as a result of all the various products currently implemented throughout hospitals, many practitioners experience substantial alert fatigue. In addition to the beeps and flashes of the many machines monitoring patient statuses, practitioners now see a constant flow of alerts in their software workflow. One study shows that three to six percent of all orders placed through Computerized Provider Order Entry (CPOE) systems result in an alert, which can add up to hundreds per day. In our research on healthcare systems, we’ve heard that while it’s good to have automated error detection, the vast majority of alerts do not correspond to an actual error and will be ignored. This diminishes the impact of all alerts, however, and could mean that crucial alerts are ignored along with the many non-crucial alerts. Practitioners in our research frequently cite irrelevant warnings or alerts as a primary criticism of products used in their hospitals.
What to know when creating products for practitioners
Hospitals are busy places. Doctors and nurses work long shifts and see many patients, often briefly. Technology products geared toward these audiences need to provide clear value and consist of quick workflows that don’t interfere with patient care. Data should be glanceable, easily understood within seconds with any problems clearly called out. Alerts need to provide clear hierarchy, with critical alerts (“something is wrong”) appearing visually distinct from warnings (“something could be wrong”). Provide system-level configuration options to ensure alerts reflect the actual processes of the hospital.
Despite the enormous amount of modern technology found in most hospitals, many computer displays used by practitioners are small and dated, and subject to lighting that may be substantially different from your standard office building. The aesthetics of products used in the hallways, patient rooms, labs, and operating rooms throughout the hospital must fit the context and display.
While these three user types represent many of the potential users of your product throughout the hospital, there are many different specific users within each — doctors, while they share many of the same goals and concerns, operate differently from nurses, and a pediatrician will have different needs and processes than those of a surgeon. Spend time talking to the people you want to use your product and, ideally, watch them at work (hospitals, as you might expect, can be harder to get access to for contextual research, but not impossible). Building a fundamental understanding of the people in the hospital who would be using your product is key to success.