I was recently asked by a friend what was the best advice I have received in my healthcare career. My first thought was “wow, that’s a tough question!” As I was racking my brain, I could have come up with something cliche like “be passionate about what you do” or “be comfortable saying you don’t have the answer”. As I was cycling through my brain, I suddenly flashed back to an early point in my career:

“If you don’t spend time in their environment, how will you know how users really use your product?”

To give some context, I was very new to the world of User Interface design and was the lead Usability Engineer for a critical care ventilator. I was working with designs coming from the anesthesia device product line to promote consistency between the products and to ease the cost of development. The Product Manager shared his Respiratory Therapy experience by sharing the common ventilator settings that needed to be programed. Here is what the RTs do, here is what the other development team is doing, figure out where it goes on the display - no problem!

But there was a problem: I had never set foot in an ICU. I heard a lot of stories, seen a few pictures, but I was designing off a lot of assumptions and from my knowledge of observing a few surgeries in the OR. Enter Terri, a former ICU nurse and great colleague and friend of mine that felt the need to not so gently guide me on the right path. I honestly can’t remember if those were her exact words, but the message rang clear. I was never going to make the best design decisions if I didn’t get a chance to observe the messy, real world environment of the ICU. It was an easier said than done solution, since most hospitals prefer that some random guy does not just walk into an ICU.

My opportunity finally came through the unfortunate admission of my grandmother into the ICU. 50 plus years of smoking, high cholesterol, and COPD will usually require the need to be placed on a ventilator. It was an emotionally difficult time, filled with potential end of life care discussions. Since she was expectedly anxious, I decided to help the family out by spending a couple nights in the room with my grandmother.

It ended up being a learning experience as I was immersed into the day to day life in the critical care environment. I was able to observe clinician interactions with my grandmother and the equipment in her room. Some things I noticed included:

Her ventilator was tucked into a corner, behind a lot of other equipment. I think I saw it touched once in 2 days.
The nurses usually came in the room, checked my grandmother, checked her vitals, and looked at the IV pumps before leaving the room. They usually didn’t glance at the ventilator.
If my grandmother coughed and trigged the high pressure alarm, no one came running in a panic…in fact usually no one came in. Alert fatigue is a real thing.
A Respiratory Therapist would come in every few hours for a nebulizer treatment. They would check the ventilator, but hardly needed to adjust anything.

Before this, I was designing under the assumption that the ventilator was under constant supervision, like an anesthesia machine. This was hardly the case. The ventilator was a life support tool that rarely needed to be adjusted compared to the IV pumps, catheters, and other equipment keeping my grandmother alive. You set it up, might make an occasional adjustment, and you just expected it to work.

After that experience, I remember coming back to work and saying “I get it now, I really get it” to Terri. I understood the environment and each clinicians interactions within that environment. I saw how busy and overwhelmed the clinical staff was. I finally realized that what I was designing was a piece of a much bigger clinical puzzle to care for a patient.

In the product development world, it is easy to have such a strong focus on the product that it is designed as if it is the most important part of someone’s day. The reality is, most of us are designing products that are just a tool…and may not be looked at for more than a few minutes over the course of the day. In healthcare, the patients really are the most important piece of that puzzle, not the technology. This is just one reason why User Research is so important in the development lifestyle. Good User Research shows the reality of the problems in a work environment allowing for smarter, more informed design solutions.

I have had a few of these reality checks in my career (here’s another great exmaple). I would like to think these experiences have made me a much better UX designer as a result.

Just remember: “If you don’t spend time in their environment, how will you know how users really use your product?”