Human Centred Design Importance Products Peer Reviewed Articles
Int J Qual Wellness Care. 2021 Jan; 33(Suppl 1): 37–44.
Innovating wellness care: central characteristics of human-centered design
Marijke Melles
Department of Human-Centered Design, Faculty of Industrial Design Applied science, Delft Academy of Engineering science, Landbergstraat 15, 2628 CE Delft, Holland
Armagan Albayrak
Department of Homo-Centered Design, Faculty of Industrial Design Technology, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
Richard Goossens
Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Engineering, Landbergstraat 15, 2628 CE Delft, The Netherlands
Received 2020 Jun xiii; Revised 2020 Sep thirteen; Accepted 2020 Oct 14.
Abstract
Human-centered blueprint is almost understanding human needs and how design tin can respond to these needs. With its systemic humane arroyo and creativity, human-centered blueprint can play an essential role in dealing with today's care challenges. 'Design' refers to both the process of designing and the consequence of that process, which includes physical products, services, procedures, strategies and policies. In this article, we address the three key characteristics of human-centered pattern, focusing on its implementation in health care: (i) developing an understanding of people and their needs; (2) engaging stakeholders from early on and throughout the design process; (3) adopting a systems approach past systematically addressing interactions between the micro-, meso- and macro-levels of sociotechnical care systems, and the transition from individual interests to collective interests.
Keywords: user-centered design, human factors, user needs, stakeholder involvement, sociotechnical systems approach, patient journey
Introduction
In recent years, new forms of patient care have been introduced to guarantee condom and high-quality care. Many of these approaches focus on organizational optimization and the needs and values of the stakeholders [1]. Examples include organizing intendance in dynamic multidisciplinary teams of medical professionals to coordinate mutual communication and diagnosis (e.g. networked care [two]), steering treatment on outcomes that matter to patients (eastward.g. value-based health care [iii]) and active patient participation throughout their intendance path (eastward.g. shared decision-making [four]). Designing and implementing these new forms of intendance involve major organizational modify and demand a holistic systemic approach towards wellness care. It also requires defended, well-designed interventions—i.e. products, services, procedures—to be used past patients, care givers and medical professionals to facilitate and implement these envisioned forms of care.
Human being-centered design (HCD), with its systemic humane approach and inventiveness towards change, can play an essential role in dealing with today's complex care challenges [ane, 5, 6]. The field of HCD revolves around discovering man needs, so equally to blueprint products or services that meet these needs. The resulting design is understandable and usable, it accomplishes the desired tasks and the experience of apply is meaningful and pleasurable [7, eight]. Characteristic of HCD is its holistic, systems approach towards man needs, ensuring that solutions fit the dynamics of the (complex) sociotechnical arrangement the user is part of. Annotation that 'design' is a broadly defined term used for both the procedure of designing and the issue of that process. Moreover, design is no longer used every bit a process to create concrete products merely, but increasingly as a process that leads to the creation of whatever type of intervention that changes existing situations into preferred ones. This includes services, procedures, strategies and policies [7, 9]. A big variety of methods and principles exists supporting the HCD process, each with its own specific purpose within the design context or phase of the design procedure [7, 10]. Examples of HCD methods range from shadowing and contextual inquiry to investigate human being needs to co-creation and usability testing to develop solutions. The HCD subject area is closely related to that of Man Factors (HF) and the terms are often used interchangeably [9, eleven]. Furthermore, there are many closely related design (research) disciplines using HCD principles and methods without explicitly being called HCD, such as user-centered blueprint, design thinking [12], service design [13], experience-based design [14] and participatory systems approach toward design [15]. In HCD, as in all blueprint disciplines using HCD principles, designers rely heavily on the tools, methods and insights from the HF discipline, equally illustrated by the definition of HCD by the International Standards Organization (ISO): 'Human-Centered Blueprint is an approach to interactive systems evolution that aims to brand systems usable and useful by focusing on the users, their needs and requirements, and past applying human factors/ergonomics, usability knowledge, and techniques. This approach enhances effectiveness and efficiency, improves man well-being, user satisfaction, accessibility and sustainability, and counteracts possible adverse effects of use on human health, condom and functioning' [xvi]. The evolution of HCD and HF started after the Second World War; they were viewed as ways to increment the efficiency of industrial production by 'fitting the task to the worker'. Since then, the focus has elaborated from the physical and cerebral characteristics of users towards their organizational, social and emotional needs and pleasurable experiences [seven, 9].
HCD is increasingly recognized as being a valuable contributor when addressing today'due south complex healthcare challenges (e.g. [5, 6].). In their editorial 'Redesigning healthcare to fit with people' in the British Medical Periodical, Erwin and Krishnan [5] aptly describe HCD's added value: 'The key is to shift our focus from helping people to fit our care delivery organization, to one where nosotros pattern our care delivery arrangement to fit people where they live, work, learn, play, and receive healthcare.' Many healthcare organizations realize that becoming more homo-centered is primal to dealing with today's care challenges. However, although HCD is increasingly existence adopted in healthcare exercise, footling has been published on what an HCD approach entails when practical to healthcare organizations. In this commodity, we address the iii key characteristics of HCD and how they relate to the context of health care: understanding people, early on and continuous stakeholder engagement and a systems approach.
Central characteristics of HCD in health care
Understanding people—solving the right problem
The emphasis of HCD is on human needs and how design tin can respond to these needs. Understanding people, how they think, how they behave and how they are influenced by their environment (i.due east. their sociotechnical system) is therefore conditional before the actual evolution of an intervention can starting time. Or, as the well-known United states of america-based design agency IDEO coined information technology in their HCD Toolkit: 'Human-centered pattern begins by examining the needs and behaviors of the people we want to touch on with our solutions' [17].
A widely used visualization of the HCD process is the Double Diamond Model (see Figure one), developed in 2004 by the British Design Council [18] and which has been applied and adapted past many designers since. The double-phased model underlines the key principle of HCD: offset finding the correct problem ('designing the right thing') and so fulfilling human needs by design ('designing things correct') [eight]. The first diamond is ofttimes referred to as the problem space, the second every bit the solution space; terms stemming from the design thinking do, a do closely related to HCD. The diamond structure emphasizes the divergent and convergent stages of the design process, referring to the dissimilar modes of thinking that designers use; a process of exploring an event more than widely or deeply (divergent thinking) and so taking focused action (convergent thinking). The HCD designer starts past questioning the problem given to them: they aggrandize the scope of the problem, diverging to examine all the fundamental issues that underlie it. And then, they converge on a trouble argument. The knowledge of users and their context is and so built on, to develop suitable solutions; the second diamond combines divergent and convergent thinking to determine an appropriate solution. First many ideas are created and evaluated, before refining and narrowing these down to the best solution [viii, xviii].
The Double Diamond Model (adjusted from [18]), visualizing of the human-centered design procedure. The commencement diamond represents the process of divergence–convergence to determine the actual problem. The second diamond combines divergent and convergent thinking to determine an appropriate solution.
Following the Double Diamond Model, the HCD design process is divided into iv main activities: Detect, Ascertain, Develop and Deliver [eighteen]. Discover is about understanding, rather than simply assuming, what the problem is. It involves studying the people affected by the issues. The insights gathered from the Discover phase aid to define the actual problem. Develop, the showtime activity in the 2nd diamond addressing the solution space, encourages designers to explore different answers to the divers problem, seeking inspiration from elsewhere and co-designing with a range of stakeholders. Evangelize involves modest-scale user testing of different solutions, rejecting those that exercise not work and improving those that do. The iv activities—discover, define, develop deliver—are iterated; they are repeated over and over, with each cycle yielding more than insights and getting closer to the desired solution [8, xviii].
A common occurrence is that the initial brief given to a designer already describes the trouble to exist solved. The human-centered designer volition always get-go by going back to investigating the problem space to verify whether the given trouble is the actual trouble. An instance of this in healthcare blueprint is given by Mullaney et al. [19] who describe how their blueprint team was asked by a cancer eye to reduce patient feet during radiotherapy treatment. The center used to focus on reducing patient anxiety by offer coping strategies taken from nursing theories on coping and disease management. Mullaney et al. started their HCD process past first investigating the situational triggers of patient feet in cancer handling, and this led to a broader understanding of the problem expanse and its solution infinite. A key trigger turned out to be the fixation technology during radiotherapy treatment; "the fixation device confines the patient to a passive, disempowered role inside its interactions due to it existence embedded with the socially scripted 'sick role"' [19]. Starting from this holistic view on patient anxiety, they reframed the problem and started their idea development stage. Another instance is Simons' blueprint projection [20], who was asked to better the patient experience of children admitted to a pediatric astute medical unit (P-AMU). Simons started investigating the problem space by observing and interviewing children, parents and medical staff and mapped their journey from beingness admitted (unexpectedly) to the emergency department (ED) to being transferred to the P-AMU and being discharged (to home or a regular nursing department). The patient journey (PJ) conspicuously showed more fluctuation in patient'south emotions and more innovation opportunities at the ED in comparing to the P-AMU. She concluded that improving the patient feel at the P-AMU started with improving the patient experience at the ED and reframed the initial blueprint cursory. Both examples emphasize the overriding principle of HCD: make certain yous solve the right problem past first acquiring a deep understanding of the people you design for.
Table one provides an overview of the HCD tools and methods as discussed in the examples in this article. Note that this overview is far from complete. It does provide an overview though of the almost mutual HCD tools and techniques used to collect information throughout the different pattern phases.
Table 1
HCD tools and techniques as described in this article
| HCD stage | Method | Clarification | Example(south) |
|---|---|---|---|
| Discover | User observations | Observing participants in specific situations in their real-life context to understand phenomena, influential variables and interrelations in real life [ten] | Shadowing staff at an orthopedic unit to sympathise teamwork [23] Observing consultations of patients with familial hypercholesterolemia to understand conversation dynamics related to medication adherence [31] |
| Interviews | Face-to-confront consultations with stakeholders to understand their perceptions, opinions, motivation and behavior [10] Can be individual interviews or in group setting. | Interviews (individual) with cancer patients on what triggers anxiety during radiotherapy treatment [xix] | |
| Generative techniques | Tools used during interviews to proceeds the deeper, more tacit cognition of participants [21] | Sensitizing booklets with three–5 small daily assignments to reflect on a certain topic (due east.g. diabetes equally experienced in daily life [22]), which are sent to the participants a few days before the interview. The assignment sensitizes and prepares the participants for the follow-upward interview. | |
| Define | Stakeholder mapping | Visual map of all stakeholder groups that relate to the blueprint problem [24] | Map of 25 stakeholders involved in child oncology, based on literature and interviews. Child patient at the center, distance between patient and other stakeholders represent the intensity of their interaction [24] |
| Patient journey mapping | Visual record of all stages patients become through during their disease, including prevention, first symptoms and rehabilitation. It covers the goals, interactions, emotions and barriers patients experience at each stage [10, 29, 30] | Patient journey mapping of patients undergoing a gastrointestinal diagnosis in order to investigate whether and how this procedure tin can be elaborated with video endoscopy engineering [28] | |
| Design | Brainstorm sessions | Artistic thinking approach with rules and procedures for generating a large number of ideas. Based on the assumption that quantity leads to quality [10] | Brainstorm session with parents of young cancer patients on how they could be involved in the medical care squad [24] |
| Co-cosmos | Whatever act of collective creativity, i.e. inventiveness that is shared by two or more people (includes designers and people not trained in design) [21] | Session with designers and orthopedic staff (nurses and surgeons) to create solutions to improve teamwork, starting from information collected during observations at the unit of measurement [23] | |
| Validate | Interaction prototyping | The use of prototypes to simulate and test how people will experience a future design. Prototype testing helps to evaluate concepts at an early on stage of development, facilitating quick learning cycles during concept development. [10] Prototypes tin can range from written scenarios and drawn storyboards to fully functioning prototypes. Research settings can range from interviewing and role playing to observing use in real-life settings. | Evaluation by medical specialists of a mock-upwards digital paradigm of an eHealth application for patients with familial hypercholesterolemia to facilitate a give-and-take on life style preferences during their annual consultation. The image was used in a function-playing setting (researcher acted as patient) [31] |
Early and continuous stakeholder engagement
Designers develop interventions (eastward.yard. products, services, strategies) intended for employ by people other than themselves; i.e. past people who have skills and experiences the designer does not share. This is particularly true for designers who work in the healthcare domain and who predominantly develop interventions that can bear upon patients and medical professionals. Gaining a thorough understanding of users' physical and mental characteristics, their needs and beliefs, and the sociotechnical context in which medical professionals work or patients cope and manage their illness is essential to develop long-term usable and useful products. To fully grasp human behavior, underlying values, and motivations, the existent user has to be studied in their existent-life situation and actively involved in the design process; engaging cease user(due south) and other stakeholders throughout the design process is therefore key in HCD.
The HCD discipline has an extensive set of tools and techniques to involve and engage stakeholders throughout the blueprint process [ten, 21], see also Table 1. Preferred methods for investigating the problem infinite, i.e. identifying human needs, include ethnography-based research such equally ascertainment and interviews, often elaborated with techniques to proceeds the deeper, more tacit knowledge of users [21]. For example, Smoorenburg et al. [22] extended their patient interviews with so-called generative techniques to investigate experienced self-direction of diabetes patients. In order to gain a thorough understanding of how patients perceive self-management, they were provided with booklets with small assignments to reflect on their daily experiences for a few days before their interview. Using these sensitizing booklets enables the researcher to quickly engage with the interviewee, prepares the interviewee for the interview, and permits elaboration on specific topics addressed prior to the interview [21]. In this way, a deeper (tacit or latent) layer of information about the perspective of the patient could be addressed during the interviews [21]. Caprari et al. [23] combined shadowing of medical staff at an orthopedic unit with learning history techniques, including personal timelines of the observed shifts which were discussed subsequently with the staff members in social club to understand teamwork from different stakeholder perspectives and to identify themes related to teamwork dynamics. They used these insights to define their concluding design direction (improving the handover betwixt physician and nurse by accounting for their differences in communication styles, i.east. numeric and emotional) and to define the contextual requirements and restrictions for their time to come design. In the second, design phase of HCD, designers can, for example, use brainstorm sessions with users or co-cosmos sessions to initiate ideation. A little farther in the ideation process, stakeholders can be asked to reflect on ideas using prototypes, which can range from sketched storyboards to paper-based prototypes to working prototypes, depending on the phase of the design procedure and the research question. Prototypes are used to simulate the user feel and thus have stakeholders imagine the use of the new blueprint as best as possible, once again to trigger deeper layers of information from the report participants. Design testing focuses on the product/service'due south usability and efficacy for the user and on the product's impact on the sociotechnical environment [10]. A holistic systems perspective in design testing is essential to ensure new designs fit the circuitous (work) context of health care.
As many stakeholders are involved in the delivery of intendance, information technology is important to select the relevant stakeholders at the start of a design project. In HCD, the stakeholders involve the envisioned stop-user(s) of a new pattern and people who influence the cease-user(southward) in some way and are, every bit such, function of their sociotechnical system. Vice versa, the piece of work or life of these people may exist influenced by the new intervention and therefore they need to be taken into account throughout the design process. Kleinsmann et al. [24] started their pattern project on parental involvement in medical cancer teams by identifying—based on literature and informal interviews—25 different stakeholder groups involved in pediatric oncology ranging from the child patient, supervising oncologist and parents to the psychologist and teacher; all were plotted on a team map. In this squad map, the patient is cardinal, as the initial design brief was to meliorate patient care through parental involvement in medical teamwork. The distance between the patient and other stakeholders represented the intensity of their interaction (greater altitude = lower intensity). They further divided the stakeholder groups in four sub-teams with their own sub-goals; medical squad, research team, psychology team and educational team. Based on the map, they decided to include eight user groups in their inquiry who had frequent confront-to-face interaction with the patient and parents. Throughout the design project, they involved 12 participants who represented the 8 different user groups. Participants were adumbral and interviewed, and participated in image evaluations. The framing needed to select the relevant stakeholders for an HCD project is based on the design brief and the context of the finish user(s). Yock et al. [25] propose dividing stakeholders into ii groups; those involved in the 'cycle of intendance' focusing on the intendance procedure of a patient and those involved in the 'period of money' focusing on the financial side of patient care. Likewise, Dul et al. [nine] identify four stakeholder groups; system actors, system experts, organisation decision makers and organisation influencers. In HCD projects like Kleinsmann's [24] or Caprari'due south [23], stakeholders are oft called based on their impact on the actual use of the pattern, and thus mainly involve arrangement actors.
Systems approach
Products and services are never used in isolation. For example, an orthopedic instrument used by a surgeon during a hip replacement process might impede the view of the other surgical team members and prevent them from anticipating the surgeon's deportment, which consequently might have a negative effect on the condom and efficiency of the entire process. In other words, changes (by introducing new interventions) and optimizations at micro-system level (eastward.m. humans using tools or performing unmarried tasks) will influence the larger meso-systems (e.g. humans equally function of teams) and macro-systems (e.thou. humans as office of organizations or societies) [9, 26]. In HCD, information technology is crucial to empathize and accost the interactions between diverse organisation levels in order to create effective solutions at an individual level and in the broader sociotechnical user-context. This broad and holistic perspective of HCD is referred to every bit a systems approach and the third primal characteristic of HCD we address hither [7, 9].
A system is a gear up of interacting and interdependent components that form an integrated whole [9]. Also, healthcare organizations tin be considered circuitous sociotechnical systems composed of people, technologies and tasks that interact in an surroundings to perform processes (physical, cognitive, social/behavioral and organizational) that shape outcome(southward) [27]. Outcomes refer to outcomes for patients, professionals and the organisation every bit a whole and tin vary from treatment adherence, patient satisfaction and squad state of affairs awareness to compliance with regulations and quality of care. In addition, there is the fourth dimension factor. Tasks and processes happen over time, where an activeness at one moment affects an activeness at a later time [27–29]. A systems approach is essential to ensure that interventions at micro-level do not negatively impact meso- or macro-systems dynamics and thus are useful and usable in the entire context over time.
PJ mapping is a well-established method in HCD to visually record the dynamics of a sociotechnical system over fourth dimension, past including all actors, interactions between actors and experiences from a patient's perspective [28–30]. Starting from the PJ, HCD designers tin identify problems and how these problems arise (making sure they address the right problem, run into 'Understanding people—solving the correct trouble'), and thus place man needs. Based on these insights, requirements and wishes for new interventions can be defined. Simonse et al. [28], for example, applied PJ mapping to elaborate gastrointestinal diagnosis health services with video endoscopy technology. They co-created the PJ with all the relevant stakeholders in order to reveal and understand the overall experience and needs of all stakeholders involved in the journey. Their project as well demonstrates how PJ mapping leads to ideas for new interventions. Mapping the PJ provides insights into current user-strategies which feeds the evolution procedure of HCD products and services.
A systems approach is as well leading in the ideation phase of HCD, where new solutions are developed and evaluated on their fit inside the (piece of work) context of the user(s). An example of a technique used here, i.e. interaction prototyping (see as well Tabular array i), is given past Thomson et al. [31] who developed an eHealth intervention to improve medication adherence for patients with familial hypercholesterolemia; a genetic condition that requires lifelong treatment past statin and other medication. Part of the production functionality was to facilitate a word of patients' lifestyle preferences with their specialist during the annual consultation. During the pattern process, a working prototype was developed, the functionalities of which were discussed with physicians in a scenario-based set up-up in order to investigate the production's perceived value and its impact on their work procedure. Based on this evaluation, the production's functionalities were optimized.
In improver to the higher up micro-meso-macro arroyo, starting from a macro-systems perspective a systems arroyo is essential to determine how to 'design' individual behavior in club to contribute to the envisioned output at an organizational level. Given the current societal challenges such as aging, limited resources and, more recently, pandemic-awareness, there is an increasing shift from the individual to the collective interest with a focus increasingly centered on the implications for an organization, customs or society. The direction of COVID-19, by, for example, introducing the concept of social distancing to reduce the disease spread or joining vaccination programs are practiced examples of this. The HCD subject can contribute to addressing these complex societal challenges past providing a much needed holistic approach.
Discussion and conclusion
HCD is virtually agreement human needs and how design can respond to these needs. In this commodity, nosotros describe the iii core characteristics of HCD: agreement people, stakeholder date throughout the HCD process and a systems approach towards the development new products, services and strategies. All iii elements are described and elaborated on in the context of health care. For highly complex matters such as patient prophylactic and quality of care, which involve multidisciplinary (sub)teams, divers work processes, many regulations and increasingly the (required) participation of patients, HCD may provide a much needed systemic and humane perspective to develop meaningful innovations to meliorate prophylactic and quality.
Although HCD can play a valuable office in health care, collaboration betwixt the disciplines is challenging. First, there is the divergence in research methodology. HCD relies heavily on qualitative research methods and user studies with small sample sizes, which is in abrupt contrast to the clinical trials and evidence-based mindset in wellness care. Convincing the medical discipline of the effectiveness of an HCD approach can exist challenging, although more than and more than medical researchers advocate the implementation of more than qualitative approaches to accelerate the improvement of systems of intendance and practice [five, 32]. Embracing a wider range of scientific methodologies, reconsidering thresholds for action on evidence, rethinking about trust and bias are some of their recommendations to broaden the evidence-based mindset [32].
Second, designers may encounter several more than practical challenges when working in the healthcare context compared to not-health domains. Based on experiences of healthcare designers, Groeneveld and colleagues [33] identified three clusters of challenges designers need to consider and deal with in practice. The beginning cluster, practical challenges, includes issues regarding conducting fieldwork, involving users and dealing with sensitive situations. Adapting to restrictions and unexpected situations, budgeted vulnerable patient groups carefully and responsibly, and effective involvement of the stakeholders throughout the whole projection were mentioned past designers every bit experienced challenges in do. The second cluster, managerial challenges, concerns relationship management and communication: Keeping stakeholders informed and engaged, recognizing differences in understanding between pattern research and clinical research, and clarifying the added value of design work to the stakeholders. Finally, the third cluster addresses attuning to time and financial restrictions. Limited availability of medical specialists in design inquiry, creating a safety and open enquiry environment to communicate easily and without prejudice were the more than generic challenges mentioned past the participating designers [33].
For wellness care to prefer an HCD approach, it is important for the HCD discipline to understand the prove-based mindset of clinicians and acknowledge the ethical considerations of doing (design) research in the context of wellness care. Starting the collaboration with a constructive alignment of the different perspectives is crucial for a trustful and sustainable human relationship. Beingness flexible and anticipating to the changes with inventiveness will increase the commitment of the stakeholders to the project, create ownership amongst stakeholders of solutions and improve implementation. Healthcare organizations are currently facing major organizational and societal challenges and changes and are looking for new and improved forms of human-centered patient intendance. Every bit a response to this shift towards a more holistic, humane intendance perspective, an increasing number of healthcare organizations acknowledge the importance of HCD approaches. We encourage healthcare organizations and HCD experts to continue to implement this much needed multidisciplinary collaboration in dealing with today's intendance challenges.
Contributor Information
Marijke Melles, Department of Man-Centered Blueprint, Kinesthesia of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands.
Armagan Albayrak, Department of Human-Centered Blueprint, Kinesthesia of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The netherlands.
Richard Goossens, Department of Human-Centered Design, Kinesthesia of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands.
Funding
The papers were funded by ISQua.
Information availability
No new data were generated or analyzed in support of this review.
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Articles from International Journal for Quality in Wellness Intendance are provided hither courtesy of Oxford University Press
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802070/
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