For Father’s Day, my parents, my wife and kids all went to my in-laws house for brunch. Ah, the glories of brunch let me siiiinnnnggg your praises (AAAHHHH AAAAAHHH AAAAHHHH!!!), you a nuanced blend of breakfast and lunch, sweets and savories, smorgasbords the world over brimming with blends of tasty bites for different appetites. Brunch mainstays can vary between countries, regions, cities, all the way down into intra-family variations. Because of the murky location to the start of brunch (early midday? Late morning?) the host must provide a variety of dishes and tastes to appease the diversity of culinary needs for their brunchers. Lean too much toward lunch, your breakfast eaters are nonplussed. Bust out too many breakfast dishes, your lunch eaters are aggravated. Just like cooking an egg soufflé (a brunch must for my mom), to design a good brunch you need to balance ingredients, environment, and timing.
When mixing brunch and family, a new layer of design complexity is added. Now one is designing around multiple traditions, preferences, and allergies. Include a low level resentment that while you always include the peanut butter on the table, you always get the wrong type. Add the shtick about the proper way to build a lox bagel sandwich with a specific set of toppings because that was how grandpa did it. Like most expressions of our shared life experience, brunch and families are illustrations of a complex system working sometime in unison and other times in discord. Anticipating and managing towards discord avoidance could easily describe every successful family function since the first days of civilization (hey, make sure your cousin from cave 76 doesn’t drink too much fermented berry juice, ok?).
While there are few similarities between designing a brunch and designing an EHR (perhaps overall bagel consumption being one of them) they both share a need for a design approach that is optimized around balancing multiple stakeholder needs, goals, perceptions and contexts. During the stellar webinar on June 19th “EHR Usability & Health IT Safety” from ONC & RTI International’s Health IT Safety Center Webinar Series, Ross C. Teague, PhD, Senior Manager of User Experience at Allscripts posed a consideration for the rapt audience around the importance of designing for stakeholder balance. He discussed how when you focus too much on optimizing a product for one stakeholder, the balance shifts between all the other stakeholders, bringing another stakeholder’s UX into discord. Optimize for financially-focused stakeholders, and clinically-focused stakeholders pay. Optimize for internal medicine, specialties suffer. The goal is to aim for “good enough” where your users are satisficed with their user experience (a combo of satisfied and sufficed). Dr. Teague urged us to consider that we are designing not around a user, but a group of users. He highlighted the need to shift from a user-centered design process to a use-centered design process.
One important reminder from Ross’s thought-provoking presentation is that it is incredible important to keep in mind that healthcare, like other data-intensive, high-risk industries like aviation, energy, etc. are complex socio-technical systems. Your personal interactions with the systems and processes you use on a daily basis are part of a larger pool of interactions taking place within your office, and of interactions between your department and the rest of the organization, and so on and so on, all which play a part in the overall health and functioning of the larger system. Not that much different from the complex, heterogeneous set of systems and actions that make up a healthy human body, and the discord of those systems when a person is ill.
As we work through the remainders of Father’s Day brunch and lingering annoyance due to family mishegas, remember that designing effective health IT is an incredibly complex process, and if you get a chance, consider buying a bagel for the hard-working designers building the systems you use. Although you may want to bring one Everything bagel and one Cinnamon Raisin, just to be safe….