Delay and confusion in the waiting room.


Hospitals are time consuming, stressful for patients and staff, and generally inefficient. One company working to change all that seems to have missed the mark for patient user experience.

The first job of a User Experience (UX) professional is to figure out who the customers are and into which groups they fall. After that identification is made,  the UX professional can separate the groups into those with similar characteristics and start testing. The purpose of testings is to reveal any broad challenges customer are having with the technology and specifically what is preventing them from being able to use a product or feature effectively. Testing consists of asking the user to perform simple tasks.  Take, for example, a movie ticketing website. To properly test that site, a user would be asked to complete one or all of these tasks; perform a search by title or location to find a movie they want to see, find a movie review, or buy a ticket. These tasks,  and many more like them,  are a necessity to understand the usability of a product, website or feature. This understanding helps UX professionals like myself make changes to improve product usability.

The other day I was speaking with a nurse who recounted one of the many reasons she no longer loves the profession she spent years pursuing. I came to understand from her the worst part of nursing is not changing a dressing or the long work hours. The worst part is not being able to connect with her patients. In the case of Michelle, who is deeply empathetic, the realization that her job had become more focused on charting than on activities involving direct patient care was disheartening. Charting is the tedious task a nurse undertakes to keep an accurate record of patient information such as their medical conditions, medication, plans of care and much more. Charts are also vital to keep the hospital running because they serve as an instrument for billing patients and insurance companies.

Michelle told me a story of how the hospital where she works implemented a system of electronic medical records (EMR) called AllScript. AllScript provided hefty tablet computers to her department so the patients can enter their own information upon arrival at the hospital.  Traditionally patients already fill out their paper forms so it seemed as if there would be little difference if the patients used a tablet instead. As it turned out, there was a big difference and it was noticeable as soon as they rolled out the new system. The patients had problems with the small boxes, low visual contrast, unfamiliar interface and more.  The problematic tablets are still in use and rather than streamline an outdated paper-based system,  the tablets have caused so much confusion the nurses now come into the lobby to help the patients fill out the forms. Not only is this inefficient, it also is dangerous.  The patients give the nurses their answers aloud which could lead to patient omissions due to embarrassment, not to mention an obliteration of patient privacy.

One detail we pay attention to in User Experience is a Mental Model. Its origins come from computer science. According to Harvard University professor of Psychology, Susan Carey, in a 1986 journal article she wrote titled,   “Cognitive science and science education”, “A mental model represents a person’s thought process for how something works.”

A simple example is what we’ve noticed with roadway round-a-bouts;  those big round circles used to ease road congestion. Depending on from where you come,  you either expect to yield to people entering the round-a-bout or you expect they will yield to you. Your mental model is shaped by your prior experience or expectations.

In the hospital that switched from a paper-based system to tablets, the Mental Model is that most everyone knows how to use a paper and pencil to fill out forms. The problem comes when you hand them something unfamiliar like a tablet when they expected to use something familiar like pen and paper.

Now, let’s go back to the User Experience professional’s first job, which is to learn who the customers are.  In this particular hospital, a large number of patients use Medicare. Medicare recipients are, in large part, Americans who are 65 or older. One shared characteristic of this user group is that, because of their age, they have had to learn to use computers in their lifetime, rather than being born a digital native. This means that some have had a hard time adapting to technology.

The problems for the patients, staff and hospitals using this system are numerous. This program has added time and stress to an already broken system as well as safety concerns and embarrassment for it’s end-users. Unfortunately, a lack of proper user testing and methodology before product launch leads to failed outcomes like this all the time.



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