Book Review: Designing for Health: The Human-Centered Approach

“Designing for Health: The Human-Centered Approach” is a compelling and concise read from industry long-timers Craig Joseph, MD and Jerome Pagani, PhD, a physician informaticist and behavioral neuroscientist, respectively. They argue that intentional, human-centered design is mandatory for making healthcare work better for providers and patients.

My Takeaways

• This is a fun, information-packed, and relatively short read at 170 pages that will engage even skimmers and TL;DR types (I have read it twice, in fact).
• “Human-centered design” sounds preachy and academic, but it’s just the idea of developing solutions that meet the needs of the intended users.
• The concepts aren’t just about software design and implementation decisions.
• You are a designer if you, or a committee on which you serve, makes decisions about screen layouts, links, forms, edits, prompts, warnings, and even whether to turn entire functions on.

This is not a purely technical exercise. I recall that Steve Jobs attributed his accidental enrollment in a calligraphy class as forming the entire design-obsessed philosophy of Apple – making hardware so easy to use that the barrier between human and machine was nearly eliminated. Microsoft would unashamedly lead PC users to hacking their Windows registry or modifying obscure settings, while Jobs was adamant that even an “on” button was intrusive and superfluous. We don’t need to get to Jobs-like levels of obsession to improve the status quo and we can choose our battles by looking that the user benefit versus the effort required to deliver it.

This book primarily addresses the needs of physicians and other caregivers rather than patients, but the concepts certainly carry over into the patient experience, which is about as far from human-centered as you can get. Clinicians who aren’t burned out, overworked, or feeling yanked like ivory tower marionettes will deliver better, more human-centered care.

Intentional design matters, the authors say. Everything that gets put in front of a clinician, stuffed into their workflow, or even left to randomness is an intentional decision. Users apply mental shortcuts to get through their day, so the design goal is to make it easy for them to do the right thing.

Six Important Concepts

1. Make it easy to do the right thing.
2. GROSS: getting rid of stupid stuff.
3. Start with the end user (and their context) in mind.
4. Transparency and predictability.
5. The stupidity of not listening to your (real) experts.
6. Continuous improvement.

Go-Live is MVP

Go-live configuration is like a company’s Minimum Viable Product (MVP) that provides core functionality that needs to be refined continuously based on user feedback. However, those users shouldn’t be asked to provide solutions. It’s the designer’s job to review observations and user feedback make the best collective decisions that balance competing needs.

Next Comes AI

It occurred to me that while EHR decisions currently dominate clinician satisfaction and burnout, AI is the next frontier. Implementing AI in healthcare will require thoughtful, human-centered design. That would be an interesting topic for the authors to address.

Conclusion

Design decisions aren’t made solely by EHR application analysts or even CMIOs. Every decision that requires clinicians to collect information, monitor an event queue, respond to patient communications, accept or reject clinical decision support recommendations, or to incorporate new research instead of old habits into deciding which button to click involves intentional design decision.

This book is a good starting point for those who recognize the value of optimizing clinician performance and satisfaction, which will trickle down to better patient outcomes.