Peter Jones may have a common name, but he's a rare animal. He's one of the few academic design experts focusing specifically on the user experience in healthcare. And we are delighted to welcome him this year as one of our expert judges for the 2010 DiabetesMine Design Challenge!
FYI, Peter has a PhD in Design and Innovation Management, and publishes research in organizational behavior, strategic innovation, and human information interaction as a visiting scholar at the Laboratory for Collaborative Diagnostics at The University of Toronto. He also runs his own consultancy, Redesign Research, and is currently writing a book.
Today, his perspectives on how improved design can help change healthcare for the better:
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DBMine) Peter, you run an online community called Design for Care and are writing a book about "enhancing the human experience of health" through design. Why is all this necessary? What would you say has been missing that we're looking for?
PJ) Design for Care is a response to the confusing array of design approaches being used in healthcare, ranging from basic user experience from web design to human factors engineering for critical medical devices. Healthcare is such a massively distributed enterprise, and much of the real innovation work is invisible.
For example, Clayton Christensen's book, the Innovator's Prescription, is all about policy and systemic change. Most of the big healthcare design conferences are architectural, and promote environmental and interior design approaches. The Health 2.0 movement is pushed by web services used by consumers. The current move to eHealth Records systems will lock institutions into massive IT infrastructures for the next decade or more. Systems and services are all talking about healthcare, but are missing the point of care.
The human experience of health is something every system or design intervention should care about. It's a value that replaces "user centered," for me anyway, since I cannot find any "users" when I explore healthcare situations. I find people — professionals and people seeking their help — making sense of changes in their personal health experience.
How does social media play into the picture?
First of all, I think what we call social media right now will evolve into its own fields of different media types. Social networking (Facebook) is quite different than community building (think of our Ning site designforcare.com) which differs from your health community and content site DiabetesMine. Social bookmarking is just what we're calling what is essentially an open tagging feature. And just what IS Twitter anyway? What will it be when it grows up? If these are all social media, then we have a limiting definition.
We're limiting our human development potential by framing it all as social media. The web was started by scientists as a social platform, we're just enhancing it with better connective tissue as we go along. If we step back from the branding and Web 2.0-ness of it all, we may see a larger media pattern developing.
So these socially interconnected resources may evolve into different information seeking and community building services. Some see the web revolving around the individual, where I see a vast collaborative service network emerging. We may take a consistent web-based identity through this system of services, but in essence the networked provision of services is what enables people to collaborate.
People collaborate about something they want to do or accomplish, the evolution of this model is not about empowering sociality to update others about your Facebook status. Social media is still quite product-centric, and when it disappears into the network of necessary communications services we'll lose some of the cognitive overload that goes along with the fascination of having to share and update everything we think is important.
So in healthcare, if we take the care perspective again, where does care occur? Where do people seek answers, friends, a compassionate response to a problem? There are plenty of touchpoints where aggregating individual responses into quick status updates makes sense. But we also have to realize professionals in practice are already overwhelmed with information overload and situation complexity. They need filters to screen relevance and significance, and not more connectivity. Institutional, community and professional networks will remain segregated for a long time, since these are forms of organizational solidarity that gives the social its context.
I don't expect to see Facebook mashups with EMRs, ever. But I would expect to see unobtrusive collaborative media, such as online journal articles showing up via recommendation filter feeds to inform known care problems within a hospital setting.
You actually study how doctors, lawyers, scientists, and others make decisions and inform product and practice design. What lessons can you share with us?
I have a specialized practice with Redesign, in that much of the research and informatics design I do is for high-end professional practice. It's an evolution of human factors and cognitive engineering, applied to interactive product and service design. That 20 years of experience in studying practice, and not consumers so much, gives me a different view of what's important in design.
Designing for practice is all contextual. Every practice, and every organization really, is constrained by the context of performance of a certain kind of work. Work is its own context as well, it "immediates" priorities and behaviors because you know what's important in your work. The social world is much more ambiguous and undirected. Professionals maintain certain traditions over long periods of time, their work practices are socialized so deeply that the details become invisible. They focus on creating outcomes for clients (patients or legal clients), which are not simple to enhance with websites and information.
With respect to healthcare practice, and all professionals, I've learned that they have to maintain many levels of care, which we could call attention, simultaneously. Physicians often take some criticism for practicing in the medical model, and that they have no time or little availability to "care." Well, the first level of care is doing no harm, and professionals are responsible for many overlapping systems that could do harm if done wrong. Certainly this is the case for other professionals as well. What I've observed is that their decision processes are closer to sense-making than rational decision making.
The recent article (and book) on Decision Trees for health is very misleading — because we can never have sufficiently optimal information to make so-called rational decisions following an algorithm. Gary Klein's decision research has shown this for 30 years now. Expert don't make rational decisions, they exhibit expert pattern matching and have better repertoires than non-experts. I take an opposite view from the rationalist model of decision trees — I find that sense-making is what people actually do, and its more humane, contextual, and more self-aware to develop a model from reality than from ideality.
What about patients? How are their decisions or experiences being revolutionized by new tools?
I'm not working as much on the patient side, which I like to call health seeking, so I'm not really sure. I cannot speak from research work in that area, but I can relate from my own observations as informed by professionals.
First of all, people are overwhelmed by choice and then by the need to trust. When there are hundreds of things to choose from, what do you choose?
These new tools (Health 2.0) need to become part of a vast service network, not a collection of independent storefronts on the web that compete for attention and position and credibility. This will be problematic after the gee-whiz phase of start-ups, because we have so few trust markers online, we have no way of certifying credibility or authenticity. On the web nobody knows you really are an avatar. And any health site could be pharma or retail in disguise.
So the biggest thing that health seekers have benefited from is just better content online. The ability to have some rough idea of a disease condition from self-directed research makes a huge difference. It may be sketchy and incomplete, or it may be research articles they don't understand. But people are showing up to their doctor's appointments with printouts and questions. This is the biggest shift in doctor-patient engagement — and it is going to be good for healthcare, because the next step for people is to take real responsibility for health.
As a judge in the DiabetesMine Design Challenge, you'll get to experience patient "crowdsourcing" up close. What excites you the most about this competition?
The best thing for me is being where the action is. Contests bring out all kinds of opportunities and possibilities, and I'm delighted to be able to review the potential for innovation for one of humanity's most difficult health challenges.
Thank you, Peter, for fitting our little contest into the Big Picture of the Healthcare and Health/Design Revolution.