Human Creativity in Healthcare Technology: Balancing Logic and Design

I was talking with Dr. Craig Joseph (Designing for Health – The Human Centered Approach, https://www.amazon.com/Designing-Health-Human-Centered-Craig-Joseph/dp/0960120505) earlier this week about human-centered design in healthcare IT and how that impacts healthcare IT (Renovating Healthcare IT – Building the Foundation for Digital Transformation, https://www.amazon.com/Renovating-Healthcare-Susan-Snedaker/dp/1032454415). We had a great conversation which will be featured on an upcoming podcast, details soon).

Designing for Health and Renovating Healthcare IT book covers

Human Creativity Prevails

We were talking about how humans are wildly creative in solving problems and meeting their needs, especially when it comes to technology. I recounted I’d watched numerous people navigate the same application in a variety of ways all to achieve the same outcome. In his book The Design of Everyday Things, Don Norman talks about how engineers design thing logically because engineers are trained to think and design logically. However, logic doesn’t always win the day when talking about technology and how humans interact with it. “When people have trouble, the engineers are upset, but often for the wrong reason. “What are these people doing?” they will wonder. “Why are they doing that?” The problem with the designs of most engineers is that they are too logical. We have to accept human behavior the way it is, not the way we wish it to be.” (*)

Simple and Logical

When it comes to designing the EHR or other healthcare technology, it’s a delicate balancing act. It must be designed logically so that the process is consistent, transparent and safe, so that the data is consistent and actionable. It wouldn’t work to have lab result values randomly displayed based on user preference, for example. Standardized presentation of data is logical and typically yields a better outcome because it requires fewer brain cycles to recognize a standardized report format than one than changes frequently. However, for many aspects of technology when we watch the user navigating it, instead of asking “why are you doing that?” we should be saying “tell me why you’re taking each of these steps.” What we might learn is that the way the system is configured is convoluted or confusing for most users or that we haven’t put the button or the tab in the most useful place. In other cases, there are perhaps six different ways to do something and user preference is fine. And in still other cases, it’s a matter of user training (or lack of training or lack of stickiness of the training).

100 People, 100 Solutions

In my conversation with Craig, he recounted watching people repeatedly tap the delete button on their phone to get back to a part of a text message containing a typo rather than holding down the space key and moving the cursor to the erroneous text. Very few people take a class on how to use an iPhone, there is no manual, and no one explicitly teaches you these shortcuts. So how do we learn them? Usually from friends sharing a new trick they learned or reading an article touting some cool hidden feature. But if you surveyed 100 smartphone users (Apple or Android), they’d have 100 different ways of doing tasks on their phone – ways they discovered through trial-and-error or through persistence or internet searching.

This underscores the notion that humans are wildly creative in solving problems and when left to our own devices, we will each find a solution based on our knowledge, skills, and persistence. These solutions are not wrong because they appear to solve our problem, but they’re not necessarily right either. They may take more steps than needed or create unintended consequences. If a user knows how to minimize a window but they don’t know how to close it, eventually the computer or the phone will bog down. The user could close those windows or restart the device to clear it, but avoiding the problem in the first place would be an easier solution if only they knew about this. In an EHR, initiating a workflow at the wrong entry point or in the wrong way can lead to broken workflows, which create downstream problems.

So what does that have to do with healthcare IT?

Just about everything.

Strive for Simple, Logical, Consistent

For systems we configure and control, we should find the simplest way to deliver on requirements. We should step back and look holistically at the changes being requested and determine how to best incorporate those so they are logical and designed around how people actually work. (Despite Norman’s comments about logic, he doesn’t argue that we don’t need logic, he argues we need more than just logic). In most software systems, there are several different ways to achieve a result. Often training tries to show you all those ways. I would argue the most effective training is to show the user one simple path for each action. Humans will be human, we’ll figure out those three or four other ways to do it on our own if we want. But to gain competency in a new system quickly, focus on one path to achieve an outcome and train just that. If your software is configured well and your training is straightforward, you might find fewer instances when users are using an incorrect workflow to achieve a result – which means fewer workarounds, fewer issues with broken workflows, and fewer IT tickets asking for something to be fixed or changed that is actually working as designed.