On the 8^th of November we celebrated World Usability Day 2007. The theme was Healthcare so we’ve invited Suzanne Currie to write this month’s Thought Leader article. Suzanne is a good friend of ours based in Minneapolis, and for the last sixteen months she has been working as a principal Human Factors Specialist at Medtronic, designing medical products. In this article, she will share her insights on applying user-centred design to medical devices.

It’s been said that Medtronic is to medical products what Microsoft is to computers. Medtronic’s 43,000 employees design and manufacture a staggering variety of medical products that are used all over the world. I joined Medtronic for a number of reasons, but the biggest draw card was working on products that contributed directly to human well-being. These are some of my thoughts as I’ve made the transition.

Firstly, it is impossible not to be emotionally affected by what one sees when observing patients and doctors using the technologies we build. For example, it took me three days to process my feelings after conducting my first observation of defibrillator patients.

An elderly couple had come in to the clinic for their quarterly check-ups and graciously allowed me to observe the procedure. After asking them some questions, the nurse investigated the implant sites and data from the defibrillators was downloaded. The tests revealed that the wife was actually very ill and was immediately scheduled for an EKG. She was warned that there was a chance she would need emergency surgery.

It was so hard to tell what this lady was thinking. Initially, she and her husband were both very quiet and did not make any eye contact with the nurse or each other. However, as the nurse continued to focus on analysing the data she began to talk to me.

She carefully told me about her medications, her alternative health practices and how much she and her husband used to love dancing when they were young. She told me how they loved travelling to different states to compete in square dancing, the friends they had way back when, and other descriptions of her life. All I could do to help her was listen, so I put my notebook down, and gave her my full attention.

This was my first ever medical observation. This experience and several others on the first day quickly introduced me to the issues of conducting observation in a medical context. Since that day, I’ve developed a personal style when observing patients, nurses, and physicians at work, taking into account the physically cramped environment, the continual interruptions, and the intensely personal and emotional nature of patient health.

As well as the emotional effects, there are a number of other challenges worth mentioning:

• Access to clinicians is very limited - if you get an hour you’re very fortunate. Getting in-depth, uninterrupted time must be done over dinner or another social context.
• Work spaces are often very tight; you may not be able to spread out your paper prototypes.
• Multiple interruptions may occur during one usability inspection, so you need to know how you will resume the inspection after an interruption.
• Sometimes a test will need to be abandoned due to a patient emergency, so you’ll want to book additional tests to account for this.
• Quantitative tests may be less useful than qualitative tests; task timings are especially challenging given the environmental issues.
• Typically a sales or support representative "owns" the relationship with the clinician-customer, and may pressure you to leave the user with a good impression.
• Always pair in-depth interviews with direct observation in the domain of use. Workflow can only be observed in the dynamic environment of the clinic.
• Terminology is critical to get right, and you should look to test the behaviour that the user associates with the term to ensure accuracy and ease of use.

In terms of design thinking, the medical products industry is 10-15 years behind other industries, such as consumer electronics. MP3 players receive so much more attention than medical products which sustain and improve life for thousands of people. There are untold user experience improvements to be made in medical products. Perhaps at some point in your career as a usability engineer, user experience researcher, or user interface designer, you will take a close look at the rich variety of work available to you in the medical products industry.

If you have any comments or questions, or to continue this discussion, please email me at stcurrie@gmail.com.