When we design with the user in mind it’s tempting to give them what they want. As we conduct user interviews, we hear that users want a faster processor, a better camera, or a smoother picture and we give it to them. But in doing this, we may be missing the forest for the trees.
If a user tells us they want a faster processor, we need to understand what they’re doing that triggers this desire. They might be super-users experiencing system slow-downs while they toggle between applications. They might do a lot of film or photo editing, or use their machine for gaming. So they want a faster processor...but what do they need? And just as importantly, what are they going to need next? The answer might not actually be a faster processor.
The idea of designing for a user’s long-term needs instead of their immediate wants isn’t new, but all too often, it’s overlooked. Sometimes this oversight is without consequence—we’ll get it right in the 2.0 launch—but instead of accepting this as good enough, perhaps it would be good to take a cue from the medical device industry, where the needs can’t be overlooked in the more hasty interest of the wants.
Consider the lowly tongue depressor.
At some point in medical history, a doctor probably said: “I really want a tool that can enable me to better see down my patients’ throats.” And if designers of the tongue depressor had stopped there—at what the doctor wanted—the tongue depressor might have been entirely different. It might have been wider, resting on the teeth and pressing down on the full width of the tongue, but potentially causing breathing problems for the patient. It might have been longer and tubular in shape, so that the doctor looked through it...if the patient didn’t gag first. It might not have even been a tongue depressor at all. It could have been a forcep-like device that pulled the tongue taut beyond the opening of the lip, similar to what professional piercers use when they need access to the tongue.
Instead of focusing on this simple want, the tongue depressor was built on what doctors—and their patients—needed. The holistic experience of using a tongue depressor, from both the doctors’ and patients’ sides, had to be considered. Because no matter how much better doctors’ views might have been through that long tube, their experience would suffer if they were in constant fear of being retched on (and their patients’ experience would suffer if they were constantly at risk of vomiting).
Tongue depressors aren’t exactly complicated medical devices, but if that many considerations need to be made for these simple wooden sticks, imagine how crucial it is, when designing a more complex device, to consider what all users of a particular tool need in the long term, rather than just what they want right now. That practice, says Tim Nayar, Ph.D.—a biomedical engineer and medical device consultant in Southern California—is the backbone of medical device design, and one he feels should be a priority for anyone who works in user experience.
But tongue depressors are easy. What if you’re trying to design a better way of setting a fracture that also allows patients more mobility, sooner? A longer-lasting insulin pump reservoir? A more versatile prosthetic leg? The distinct needs of doctors, nurses, technicians, patients, and caregivers have to be considered, and designers of medical devices have to create something that works for all of them.
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Just like in other industries, in the medical device industry, Nayar tells us, almost nothing happens without first talking to the users. But in the medical device industry, it’s marketers who own the initial conversations—and they talk to everyone who could potentially be affected. “Generally, the first stage is owned by the marketing team. They go out and talk to the users, and say ‘hey, what issues are you encountering?’” Doctors may report that patients come to them with a common issue, or that they’re finding a certain procedure or treatment protocol to be particularly challenging; patients may express common concerns about their treatment or prognosis; caregivers may indicate that it’s particularly difficult to stay in compliance with a certain element of their responsibilities.
The job of the marketing team, Nayar says, “is to distill what the actual complaint is, not just the symptom. If a patient says: ‘my heart doesn’t work and I’m at risk for dying,’ you’re not trying to stop death but you are trying to understand the common cardiac issue.” In other words, a patient may request an implant to keep their hearts beating, but the marketing team will take the data they collected and determine that the underlying need is for an implant that widens a defective valve they all have in common. If they only considered what the patients wanted for short-term relief, they risk missing a way to solve a much greater problem, the real problem.
Once the marketing team has given the research and development team a clear understanding of the larger problem they should be trying to solve, Nayar says, R&D can think about possible fixes. Solutions need to be reliable and trustworthy—something patients don’t have to worry about failing if they fall asleep. They need to be easy enough to use that patients aren’t fussing over them all the time, or constantly returning to the doctor for tune-ups. The finished product, according to Nayar, should mean “the patients can get back to their lives.”
Because functional medical devices can often mean the difference between life and death, the medical device industry is highly regulated in most developed countries—and the riskier the device, the longer the approval process. Nayar, who is based in Los Angeles, tells us that in the U.S., groundbreaking devices can take 10–20 years to be approved by the FDA.
To get approval, the investigational device, as the final prototype is known, must become the subject of a formal study. According to Nayar, these studies are very controlled and very expensive, “but patient safety is of the utmost importance and it’s really the only way to hone in on the best design.”
Assuming the study went well overall and has received the necessary FDA sign-off, R&D must reconvene to review their results and finalize their design. At this point, the process may be familiar again to UX designers in other fields: not only do the designers here have to think about the final finished product, but they must also break it up into a series of component parts. What will they be made of and how will they be made? How can thousands of these devices be made to the same specs every time? Designers must work with the quality team to ensure that each device meets the necessary specs.
Finally, the new—and perhaps groundbreaking—technology is ready for doctors and patients.
That doesn’t mean that the first device to hit the market is the final version, though. Biomedical engineers like Nayar keep their eyes on users’ needs long after launch, and are always looking for ways to refine existing technology to meet and anticipate new needs. If they weren’t, Nayar says, a pacemaker would still be the size of a mini-fridge and patients could expect to live about 100 days longer than they would have without the device.
The original pacemaker design was a fix without functionality: doctors and patients wanted something that could correct heartbeat abnormalities, and researchers had been so intent on fixing this particular problem that they gave little thought to the needs beyond it. But as pacemaker designers began paying more attention to users’ experiences, over time they were able to make the lifesaving device smaller and longer-lasting. “They talked to doctors who said it was easier to implant flat things into the body than round things,” Nayar related. And a smaller, flatter device also meant a smaller incision that would heal more quickly.
Patient feedback, too, weighed in on subsequent iterations of the pacemaker. “The patients would say, ‘yeah, I have a pacemaker but I want to have a life. I want to play with my kids. I want to be around microwaves,’” Nayar explained, alluding to device interference sometimes caused by microwaves in earlier pacemakers. “When patients told researchers about their everyday activities, the device makers said, ‘hey we need to protect these devices from microwaves’” and improve them to accommodate other everyday needs.
Even today, nearly 60 years since the first successful implantable pacemaker was used, the device is still revisited frequently by biomedical engineers. Recent concerns that hackers can remotely disable patients’ pacemakers, for example, led to updated software being installed on over half a million devices.
Practically every person on this planet will encounter a medical device at some point in their lives. From the tongue depressor to the pacemaker, and all devices between and beyond, the devices have to improve the lives of their users—medical professionals, patients, caregivers, or some combination of these—in some way. Most designers in the broader UX field, Nayar tells us, might not need to get government approval to launch their products, but if they pay as much attention to determining what each user needs “while still making sure you build the proper thing that meets what the user wants”—as the designers in the medical device field do—“that’s how you know you’ve engineered a good product.”
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