Tuesday, 20 January 2015

Designing, documenting, buying, using: the mind-boggling hob

I have complained before about how difficult some taps are to use. These should be simple interactive objects whose design requirements are well understood by now, and yet designers keep generating new designs that work less well than previous models. Why is there so much emphasis in unnecessary innovation, as if innovation is inherently a good thing?

Ursula Martin has just introduced me to the unusable hob:
"This bizarre thing requires you to select a ring with the rotating arrow before applying plus/minus.  Now here's a thing. Suppose you have switched on ring 1 (bottom right), and no others, set it to 4 (a red 4 appears due South of the Ring 1) and a few minutes later you decide you want to turn it down to 3. How do you do that? Press the minus sign, as that is the only ring that is on? Oh no, nothing happens if you do that. it appears that you HAVE TO CYCLE THROUGH ALL THE OTHER RINGS AND BACK TO 1, then red 4 will start to flash, and then the minus/plus signs will change it. Just imagine the hoopla of doing that when you have four rings going at once."

The instruction manual is full of information like:
"Each cooking zone is equipped with an auto-
matic warm-up function. When this is activa-
ted, then the given cooking zone is switched
on at full power for a time dpending on the heat
setting selected, and is then switched back to
the heat setting set.

Activate the automatic warm-up function by
setting the required heating power by touching
the (+) sensor (5) first. Then the heating level
„9” is displayed intermittently on the cooking
zone indicator (3) with the letter “A” for around
10 seconds."

And so on, for many pages (spelling mistakes an added bonus). This is a manual that opens with the (only slightly patronising):
The plate is exceptionally easy to use and extremely efficient. After reading the instruction manual, operating the cooker will be easy."

Ursula notes that: "The designer seems to have a mythical cook in mind who doesn’t want to change the temperature very often". Alternatively, maybe it's from the Dilbert school of design. All one can be sure about is that the design team apparently never use a hob, and that the technical authors who have written the 28-page manual on how to operate this hob were happy to write out inscrutable instructions without ever seriously considering their comprehensibility. And had apparently also never used a hob.

Finally, Ursula reported that "the flat owner is very embarrassed about it - he has just had the kitchen redone and I am the first tenant since, and he hadn’t used the thing himself". If you've ever bought a new appliance and tried to assess its usability before purchase you will probably sympathise with the landlord. It's usually impossible to test these things out before buying; to even read the manual; or to get any reliable information from the sales team about usability. In fact, ease of use, usability and fitness for purpose don't feature prominently in our discourse.

We really do need a cultural shift such that fitness for purpose trumps innovation. Don't we?

Friday, 9 January 2015

Compliance, adherence, and quality of life

My father-in-law used to refuse presents on the principle that all he wanted was a "bucket full of good health". And that was something that no one is really in a position to give. Fortunately for him (and us!) he remained pretty healthy and active until his last few weeks. And this is true for many of us: that we have mercifully little experience of chronic ill health. But not everyone is so lucky.

My team has been privileged to work with people suffering from chronic kidney disease, and with their families, to better understand their experiences and their needs when managing their own care. Some people with serious kidney disease have a kidney transplant. Others have dialysis (which involves having the blood 'cleansed' every couple of days). There is widespread agreement amongst clinicians that it's best for people if they can do this at home. And the people we worked with (who are all successful users of dialysis technology at home) clearly agreed. They were less concerned, certainly in the way they talked with us, about their life expectancy than about the quality of their lives: their ability to go out (for meals, on holiday, etc.), to work, to be with their families, to feel well. Sometimes, that demanded compromise: some people reported adopting short-cuts, mainly to reduce the time that dialysis takes. And one had her dialysis machine set up on her verandah, so that she could dialyse in a pleasant place. Quality of life matters too.

The health literature often talks about "compliance" or "adherence", particularly in relation to people taking medication. There's the same concern with dialysis: that people should be dialysing according to an agreed schedule. And mostly, that seemed to be what people were doing. But sometimes they didn't because other values dominated. And sometimes they didn't because the technology didn't work as intended and they had to find ways to get things going again. Many of them had turned troubleshooting into an art! As more and more health management happens at home, which means that people are immediately and directly responsible for their own welfare, it seems likely that terms like "compliance" and "adherence" need to be re-thought to allow us all to talk about living as enjoyably and well as we can – with the conditions we have and the available means for managing those conditions. And (of course) the technology should be as easy to use and safe as possible. Our study is hopefully of interest: not just to those directly affected by kidney disease or caring or designing technology for managing it, but also for those thinking more broadly about policy on home care and how responsibility is shared between clinicians, patients and family.

Wednesday, 7 January 2015

Strategies for doing fieldwork for health technology design

The cartoons in this blog post are  from Fieldwork for Healthcare: Guidance for Investigating Human Factors in Computing Systems© 2015 Morgan and Claypool Publishers, www.morganclaypool.com. Used with permission.
One of the themes within CHI+MED has been better understanding how interactive medical devices are used in practice, recognising that there are often important differences between work as imagined and work as done.  This has meant working with many people directly involved in healthcare (clinicians, patients, relatives) to understand their work when interacting with medical devices: observing their interactions and interviewing them about their experiences. But doing fieldwork in hospitals and in people’s homes is challenging:
  • You need to get formal ethical clearance to conduct any study involving clinicians or patients. As I’ve noted previously, this can be time-consuming and frustrating. It also means that it can be difficult to change the study design once you discover that things aren’t quite the way you’d imagined, however much preparatory work you’d tried to do. 
  • Hospitals are populated by people from all walks of life, old and young, from many cultures and often in very vulnerable situations. They, their privacy and their confidentiality need to be respected at all times.
  • Staff are working under high pressure. Their work is part-planned, part-reactive, and the environment is complex: organisationally, physically, and professionally. The work is safety-critical, and there is a widespread culture of accountability and blame that can make people wary of being observed by outsiders.
  • Health is a caring profession and, for the vast majority of staff, technology use is a means to an end; the design of that technology is not of interest (beyond being a source of frustration in their work).
  • You’re always an ‘outsider’: not staff, not patient, not visitor, and that’s a role that it can be difficult to make sense of (both for yourself and for the people you’re working with).
  • Given the safety-critical nature of most technologies in healthcare, you can’t just prototype and test ‘in the wild’, so it can be difficult to work out how to improve practices through design.

When CHI+MED started, we couldn’t find many useful resources to guide us in designing and conducting studies, so we found ourselves ‘learning on the job’. And through discussions with others we realised that we were not alone: that other researchers had very similar experiences to ours, and that we could learn a lot from each other.

So we pooled expertise to develop resources to give future researchers a ‘leg up’ for planning and conducting studies. And we hope that the results are useful resources for future researchers:

  • We’ve recently published a journal paper that focuses on themes of gaining access; developing good relations with clinicians and patients; being outsiders in healthcare settings; and managing the cultural divide between technology human factors and clinical practice.
  • We’ve published two books on doing fieldwork in healthcare. The first volume reported the experiences of researchers through 12 case studies, covering experiences in hospitals and in people’s homes, in both developed and developing countries. The second volume presents guidance and advice on doing fieldwork in healthcare. The chapters cover ethical issues, preparing for the context and networking, developing a data collection plan, implementing a technology or practice, and thinking about impact.
  • Most of our work is neither pure ethnography nor pure Grounded Theory, but somewhere between the two in terms of both data gathering and analysis techniques: semi-structured, interpretivist, pragmatic. There isn’t an agreed name for this, but we’re calling them semi-structuredqualitative studies, and have written about them in these terms.

If you know of other useful resources, do please let us know!