A guide to Human-Centered Design in healthcare

By implementing a Human-Centered Design approach, healthcare technology can maximize its positive impact while minimizing potential harm.

Human-Centered Design (HCD) is a methodology that prioritizes human interaction to address user challenges. It involves an iterative process, user feedback, and a deep understanding of user needs.

Applying HCD in the healthcare sector poses unique challenges due to data privacy policies, industry-specific standards, and stringent regulations. Time constraints on medical staff add a layer of complexity. Despite these hurdles, finding practical solutions is challenging but possible.

This article highlights the crucial role of patient and caregiver experiences. It also explores four fundamental HCD principles and illustrates them using contrasting case studies. Let’s get started!

HCD’s relevance to healthcare can’t be overstated. It enables viewing problems from the perspective of those they affect most and facilitates nuanced solutions that might otherwise be missed. 

A huge yet solvable source of clinician frustration is electronic health records (EHRs). These records are a mandatory, ongoing part of healthcare, yet the more difficult the data entry process is (usability), the more under-resourced clinicians are while attending to patients' needs.

In 2019, study findings from the Mayo Clinic revealed that EHRs performed in the “not acceptable” range using the well-established System Usability Scale (SUS). Participating physicians gave EHRs an average score of 45 out of 100. For comparison, the popular search engine Google’s usability is significantly higher, scoring 93 out of 100 on the same scale.

This underperformance is but one significant opportunity for HCD to improve the user experience in healthcare. At its core, HCD enables understanding of problems from the perspective of end users, allowing for nuanced insights and identification of obstacles, as well as simple solutions that may have been overlooked.

In the healthcare industry, there are two main types of user experiences to consider: the patient experience (PX) and the clinician experience (CX). Both experiences face complex and inherently different challenges. 

Patient experience (PX):

PX in healthcare encompasses communication, the care environment, and the effectiveness of medical treatment. It defines how patients perceive and feel about their care journey—from initial interactions with medical teams to overall satisfaction.

The American healthcare system faces criticism for lacking patient-centricity in several key areas:

• Insufficient preventive care—There’s an emphasis on reacting to treat symptomatology and diseases rather than a preventative approach, which can be contrary to fully meeting patients’ needs.

• Communication and information sharing—Challenges accessing medical records and a lack of timely or transparent communication from providers can lead to stress and misunderstandings.

• Fragmented care—When multiple providers are involved, a lack of coordination and system fragmentation can result in disjointed treatment.

• Access—Disparities in access based on income, geography, and insurance coverage contribute to unequal patient experiences.

• Billing and financial transparency—Complex billing and unclear cost explanations can cause frustration.

• Volume vs. value—Fee-for-service care systems prioritize the number of services over value and outcomes, potentially compromising patient well-being.

• Limited patient involvement in decision-making—Some patients feel left out of decision-making, which can impact how well their care experiences match their values and preferences.

Clinician experience (CX):

In the context of this article and getting acquainted with HCD, CX refers to the satisfaction and well-being of clinicians—healthcare providers like physicians and nurses. (However, in conversations about marketing or UX "CX" can also refer to customer experience).

Designing CX effectively is highly relevant to preventing burnout, ensuring accurate diagnoses, precisely managing electronic health records (EHRs), and delivering timely critical care. 

As a component of HCD, CX pertains to the day-to-day challenges clinicians face as they support patients—from the practical dimensions of care delivery to patient relationship management and adapting to a continually evolving care services landscape:

• Fragmented care coordination—Similar to patients, medical teams often face challenges coordinating care, especially when dealing with multiple providers and specialists. Fragmentation in the healthcare system can result in disjointed care plans and information gaps.

• Wellness and emotional support—Healthcare professionals often provide emotional support to patients but may lack adequate support themselves. The healthcare system does not always address the emotional well-being of medical teams. Clinician burnout is a well-documented problem (and not unique to for-profit medical systems).

• Accessibility and training—Clinicians may encounter barriers to the resources and training necessary for staying on top of the latest treatment protocols and advancements. For instance, they may face challenges accessing up-to-date clinical guidelines and training modules, potentially solvable by ​​a centralized, user-friendly digital platform that provides easy access to relevant literature, guidelines, and training materials.

• Interoperability and tech barriers—HCD principles help create digital tools for medical teams that are easy to use and cater to their specific needs. This improves both CX and the patient experience. Ensuring digital tools are user-friendly and work well together reduces distractions and makes it easier for medical teams to share and use patient information effectively.

• Synchronizing support services—Efficient coordination with support services is vital for medical teams, and integrating HCD principles can enhance this collaboration. For instance, consider a scenario where a medical team relies on timely diagnostic reports from a laboratory service and consultations from a radiology service. A lack of effective coordination with these support services, if not designed with HCD in mind, could cause critical delays, impacting the medical team's ability to make informed and timely decisions. 

These core principles can assist in achieving human-centered design in healthcare settings:

These case studies emphasize the pivotal role of HCD principles in shaping effective and user-friendly solutions:

Missing meds and struggling to recall 20 different screens

A field study of a hospital's medication order-entry system, detailed in the Journal of the American Medical Association, highlights significant usability issues contributing to medication errors.

The study identified problems like date description errors—the interface let users specify medications for "tomorrow." When surgeries were scheduled late in the day, and medication orders were entered after midnight, patients would miss a day's worth of medication. Additionally, new dosage commands were not checked against previous ones, leading to patients receiving the sum of old and new doses (!)

Poor readability and memory overload were also critical issues. Small font sizes and alphabetical patient listings caused users to select the wrong patients. The interface's complexity required users to navigate up to 20 screens to review a patient's medications. The well-known limits on human short-term memory made it impossible for users to recall that much detail. A survey revealed that 72% of staff often felt “uncertain” about medications and dosages. 

This study underscores the importance of HCD principles, suggesting improvements such as clearer default values, checks for conflicting commands, enhanced readability, reduced memory load, and simplified workflows.

From 0% to 96%: health worker training improves childhood immunization rates 

In 2021, Ethiopia confronted a pressing issue with nearly 800,000 children missing routine vaccines, posing severe health risks. Acknowledging the urgency of immunization in 2023, Ethiopia's Ministry of Health collaborated with Last Mile Health and the vaccine alliance GAVI, to tackle this challenge. 

They introduced evidence-based training for over 40,000 community health workers using an innovative, blended learning format, seamlessly integrating in-person and digital sessions. The project specifically aimed at enhancing immunization training for community health workers, emphasizing key interventions such as addressing zero-dose children, reducing missed opportunities for immunization, implementing catch-up immunization, and integrating services with other health aspects.

Through household-to-household visits, community health workers identified and mapped children with zero doses, significantly improving zero-dose cases from 59% to <1% and under-immunization from 41% to 23%. Ultimately, 96% of children were fully vaccinated for their age by the second follow-up.

This success underscores the pivotal role of robust training for community health workers, aligning with HCD principles. The tailored approach not only addresses the unique needs of healthcare providers but also ensures that interventions are user-centric and adaptable. As Last Mile Health plans to replicate this model, the emphasis on HCD guarantees that future training will evolve based on data and health worker feedback, ultimately advancing health outcomes for children in underserved areas.

Unlike in the tech industry, the "fail fast" approach is unsuitable for healthcare, where mistakes can be fatal. Human-centered design is a critical factor in providing quality healthcare, but it can be challenging to get it right. 

Although there are obstacles like HIPAA regulations, time constraints for clinicians, industry reluctance to change, and regulatory considerations, hope remains. Medical workers can recognize the importance of HCD and make room for proper design processes while maintaining an open mind toward innovation.

On the other hand, designers can focus on patients' and clinicians' needs while incorporating HCD principles into their processes. By working together, we can create a more responsive and patient-centric healthcare system.