User Experience Design is everywhere. We tend to associate the discipline with websites and software development, but the more time you spend thinking about the experience a user has while interacting with your device or system, the more you start to realize that UXD is an all-encompassing methodology on designing a great experience no matter what the circumstances. As consultant Whitney Hess says, user experience design is a philosophy on how to treat people. When you live in the world of UXD, you start to see that the principles of designing an effective user-centric experience can be applied to so much of our daily lives, from visiting the dentist to applying for a mortgage to shopping for groceries... and of course to creating that killer new mobile app.
I recently found myself in a situation where I got the opportunity to think about the user experience of going through the E.R. at my local hospital. There was no software application for me to use, or gadget to interact with, but nonetheless it was an experience that certainly could have been improved through better design. Like I said, UX is everywhere!
A Matter of Perspective
What is it they say? “Don’t sweat the small stuff... and, it’s all small stuff”.
When a doctor tells you, though, that you are lucky not to be paralyzed, it’s pretty easy to forget the small stuff.
I was up at a local mountain snowboarding with a few friends. The sky was clear and it hadn’t snowed in a while, so the runs were groomed and icy in parts. We were on the last couple of runs for the evening and as we disembarked from the chairlift I called out, “who wants to see me do some jumps?”
I’m guessing that you can see where this is going.
What Goes Up...
I am by no means a highly skilled snowboarding trickster, but I do enjoy getting air and launching myself off the man-made ramps in terrain parks. Plus there’s that nefarious genetic code which drives some of us to thrill-seek (how evolution hasn’t selectively eliminated the “stupid bravado” gene I’ll never know).
So I lined myself up to a respectably sized jump, got up some speed - probably a little more than I actually needed - and propelled myself off. I remember thinking right before I was airborne that my goggles were sliding down a little. I’m not sure if that single thought was enough, but for whatever reason I left the ground leaning too far back on my board. I was in the air for mere seconds, but it felt like everything was moving in slow motion. I began rotating backwards. My friends, watching along the side of the terrain park, at first thought I was crazy enough to be trying a back-flip.
“This won’t be good,” is the last thing that crossed my mind before I hit the ground. I landed on my back, just at the base of my neck, my feet and snowboard looking down at me from above. My head snapped back and ricocheted off the icy snow. I felt no pain, at least initially. But my arms and legs spasmed and I couldn’t move for about 5-10 seconds from temporary paralysis. I slid to a stop amongst cries from fellow riders of “oh my god, dude, are you okay?” Gradually, I began to regain the ability to move.
The Waiting Game
The next 14 hours of lying immobile in a hospital gurney gave me plenty of time to think about UX issues in the hospital experience. I couldn’t help it - I guess my brain just works that way. Like I said, once you start looking through a UX lens, you start to see UX issues everywhere (for fun, check out #UXFail on Twitter).
I want to pre-emptively emphasize that the level of care and I treatment I received from the nurses and doctors was top-notch. I am forever grateful to all those who looked after me. But there are obviously no UX designers on staff at hospitals, which, when you think about it... is kind of crazy when the purpose of medicine is the care and treatment of people. Hospitals, and especially the E.R., are faced with the classic problem of high demand for limited resources. If you’re a business, this is a good problem to have. If you’re trying to treat illnesses and injuries, it is a constant exercise in coordinating priorities, allocating resources and manpower, and basically just trying to make sure no one dies.
The main issue I had with my hospital experience I believe comes down to information flow.
When I explained to the triage nurse that I had potentially injured my neck or back, they immediately got me lying down on a gurney in a neck brace. And then the hours started to tick by. Me, lying immobile in a hospital corridor, with no idea when a doctor would get the chance to see me. Not knowing what the extent of my injuries were. Trying not to freak out.
Finally, a resident leaned over me and began to take a history. An hour or so later, I was seen by the attending physician. She told me that the hope was that I just had a bad case of whiplash, and possibly sprained (hyper-extended) my spinal cord, but that it wasn’t anything more serious than that. Nothing a little rest couldn’t solve. But to be sure, they needed to perform a CT scan of my neck and upper back.
My Mountain Bike is a Smoother Ride...
More hours ticked by. It was the middle of the night now, but they have people working in radiology 24/7, so I eventually got in for my CT scan. My trip on the gurney to the CT machine brings up one of my bigger contentions with the whole experience. I’m lying on my back on a gurney with minimal padding, with a possible spine injury, and they have to wheel me through the hallways, up the elevator, and into a different ward. Let me tell you, I felt every bump, uneven flooring, and grate that that gurney passed over. The worst was going in and out of the elevators across the gap.
I realize it would be small added expensive to the hospital budget to have gurneys with some sort of shock-absorbing mechanism, but you would think that with all the developments in modern medicine, providing a more comfortable transport experience for a patient with a spine injury would be a no-brainer. Maybe hospitals just don’t want to pay this guy patent fees, but I bet a junior mechanic could come up with some sort of inexpensive shock absorbing system in a weekend of tinkering.
But I digress...
Give it to Me Straight, Doc
Like I said, the main UX issue I had was with the information flow. The doctors couldn’t tell me much before getting the results of the CT scan, except for hypotheticals, so the diagnoses didn’t really start coming until the results were in.
I could tell immediately from the doctor’s expression that she didn’t have good news for me.
“What the verdict?” I asked?
“Well,” she started, concern written all over her face. “The CT scan shows a fracture on your spine.”
“How bad is it?” I asked.
“Well...” she said. “It’s not good.”
I had what’s called a burst fracture on my C7 vertebrae. A vertebrae at the base of my neck had exploded. When I heard the news I lost it. So much for that bravado gene.
I began to ask questions about what exactly this meant, but the doctor told me that I need to be transferred to another hospital where they had a dedicated spinal ward, and they had already called the spinal surgeon on call to come in and see me. She said that it was likely that I would require surgery. She also told me that the fact that I wasn’t paralyzed was a good sign. I was lucky to not have severed or damaged my spinal cord in the accident.
To the Spine Lab!
I was strapped to a spinal board and transferred via ambulance to the other hospital. A few hours later I saw a spinal resident who explained that I would be getting an MRI to assess the extent of the injury. He told me that, if I was lucky and the ligaments which hold the vertebrae in place were all intact, there was the possibility that I could avoid surgery. But there was a backup in people waiting for an MRI, so it was possible I wouldn’t be able to get in for the scan until sometime on Wednesday. It was 3am Tues morning.
A few hours more and the attending spinal surgeon came to see me. He said that it was likely that I would need surgery, which would involve an incision at the front of my neck to place a metal plate on my spine to stabilize the area. It was also possible that they might need to operate at the back of my neck and fuse some vertebrae together.
I was fortunate to not have to wait an extra day, and I got the MRI Tuesday morning at around 8am. An hour later they moved me from the ER to a bed in the spinal ward. Eventually a different spinal resident came to see me. He said that he had discussed my case with the attending spinal surgeon, and the the results of the MRI indicated that I could probably be sent home without surgery.
I would still have to wear a neck brace, or one of those funky halo contraptions with screws going into your forehead, for 6 to 8 weeks, but anything sounded better than surgery at that point. They did a couple of more X-rays of my spine with me sitting up, to see how my back held up under its own weight, and then eventually discharged me with just a neck brace and a prescription for some opiate-based pain killers. Hallelujah.
I arrived in the ER at 9:30pm Monday night, and left the next day at around noon. And like I said, every time I got to talk to a doctor or nurse, they were nothing but kind, compassionate, and helpful. But of the 14-15 hours I was in the hospital, about 25 minutes total could be attributed to conversations with health care professionals, another hour for all the tests, which leaves approximately 13 hours where I was immobilized, in considerable pain, lying on a gurney staring at the ceiling, having no idea what exactly my future had in store. Would I need surgery? Was there still a chance that I could become paralyzed? What would it mean if I needed surgery? What would the recovery process be like? If I didn’t need surgery, what did that mean? How soon would I be back to normal, if ever? It was an exhausting emotional rollercoaster of a ride.
But did it need to be? With such limited resources that the hospitals have, there’s probably not much improvement to be had on the length of time necessary to get through the process. There’s just too many patients, only so many machines to go around, and a limited number of specialists, especially overnight. So given these constraints, how can the user experience be improved? I believe, like I mentioned before, it comes down to information flow. The hardest part of the whole experience, at least for me, was not knowing what to expect. I wanted it laid out for me... if scenario A, then B; if scenario C then D. Kind of like... wait for it... a flow chart! (If you’re more of the UML type, an activity diagram would work just as well.)
I Have a Fever... and the Only Prescription is More... um... Diagrams?
Doctors are, understandably, hesitant to make predictions or diagnoses without all the facts or test results in front of them. Or if they aren’t a specialist in the area - for example spine injuries in my case - they are more comfortable deferring any opinions to the experts. This may be a legal thing, I’m not sure. I’m not a doctor. But I couldn’t help but think how helpful it would have been for me, early on in the hospital experience, to have a breakdown of the possibilities I was facing. By not having any idea of what to expect, the mind can take you to all sorts of doomsday scenarios.
Enter UX for Doctorstm! Now I realize that every patient is different, so doctors or nurses would have to be comfortable pulling out a whiteboard or sketch pad and drawing out flow charts on the fly. But imagine if they did! Here is what mine would have looked like.
A Surreal Experience
While I was in the hospital I remember thinking that everything seemed a little surreal. You hear about people being in accidents, breaking their neck, and becoming paralyzed, but of course you never think it will happen to you. But none of us are invincible. I’m thankful to the medical staff and to the health care system that took care of me. Medicine is an old yet constantly growing profession, and new discoveries are made every year to help keep us all healthy and maintain a high quality of life. I wonder though if some of the techniques of UX design and Information Architecture could help improve the whole experience. We trust doctors because of the knowledge that they have, the years of study that they have put into their discipline, but being a good doctor or nurse doesn’t necessarily make you a good communicator. And as I learnt first hand, information is critical to keeping a sound mind while going through a traumatic experience. If you know what’s coming, you can mentally prepare yourself. My ideal hospital would have a whiteboard for every bed and a user experience designer on staff (pancreatitis? here’s the flow chart for what to expect). Actually, in my ideal world every company and organization would have a UX designer on staff!
Back to reality though, I realize that this isn't ever going to happen. But here's some food for thought before I sign off. IBM is looking at using their Watson supercomputer to help with diagnosis and treatment of medical problems in partnership with WellPoint Inc., one of the U.S.'s largest health insurers. With something like that in place, it wouldn't be too much of a stretch to imagine Watson generating and printing out a diagnosis and treatment plan diagram as part of its services.
Humans are inherently visual creatures. We absorb the information presented in graphics and diagrams much faster than written or spoken words. So next time you find yourself in the doctor’s office, ask them to give it to you straight... and then ask them to draw you a picture.