Category Archives: user experience

the user experience of healthcare

I’ve worked for software companies for my professional life.  Coming to work in healthcare has been eye-opening for me.

The user experience is … well, let’s be generous.  Let’s call it “challenging”.  And it’s challenging for, as far as I can tell, everyone involved.

It’s challenging for the patients themselves.  Getting care is no simple matter.  There are decisions to be made, providers to find, waiting lists lurking.  There are healthcare and wellness apps which promise to help the patient in some way.

It’s challenging for healthcare providers.  We’ve seen an explosion in everything related to healthcare.  There is an ever-increasing amount of data.  Some of it is specific to a single visit with a patient, such as the results from blood work or an MRI.  All of this data, not to mention whatever notes are jotted down or diagnoses given or prescriptions filled, are aggregated into a patient’s healthcare record.  Any given patient likely has multiple of these health records, even if you only consider that a patient probably has a different health record with their primary care physician than they do with their dentist.  Keeping up with all of this data is difficult and time-consuming.

And that’s just the medical side of it.  We haven’t touched the administrative side of matters, which involves the patients, family members or other caregivers, the patient’s insurance company 1, administrators and office staff at the healthcare provider, and so much more.

All of this adds up to a bad user experience.  Some of the bad user experience is just annoying.  But, since we’re talking about healthcare, a bad user experience has risks far beyond annoyance.  A patient could choose to delay treatment because navigating the system just to get an appointment is too difficult and time-consuming.  A clinician could miss an important detail in the patient’s health record and prescribe the wrong treatment.  A data-entry clerk in the doctor’s office could make a typo that results in the patient’s insurance company rejecting the claim.

I’m sure you can imagine that I read “Why Health Care Tech Is Still So Bad” with much interest, and I agree with almost every word of it.  The only point that I disagree with is that it’s not enough for physicians to be unable to live without a given technology.  There are many technologies that physicians today can’t live without.  Whatever technology is part of getting the user experience of healthcare right has to make the whole process better for everyone, not just the physician.  If my doctor thinks the technology that gives her my health record is something that she can’t live without, that is almost useless to me if she refers me to another doctor who can’t access that health record.

There are too many moving parts in the system, too many stakeholders.  It’s not sufficient to get it right for just one of them.  We’ll probably get there in a piecemeal fashion, improving experiences for different sets of stakeholders at different points.  We can’t stop because we’ve gotten it right for the physician.  The user experience of healthcare goes far beyond the physician.

  1.  I’m being lazy here, there’s also public payers like Medicare or the Veterans’ Administration.

finding my people

A couple of weeks ago, I had the opportunity to attend an event hosted by the US Digital Service.  I got a last-minute invitation to attend, I didn’t have any plans, I didn’t really know what the US Digital Service is but I rarely get email with the seal of the White House on it, so I figured I might as well attend.  It was so very much worth my time.  I learned that USDS are my people, which is something that I’ve been kind of lacking at Genentech.

My new role is pretty awesome.  I work on Genentech Access Solutions, which is a program where we help patients get access to the medicines that they need.  At first gloss, this doesn’t necessarily sound like it’s a good fit for someone with a UX background.  It’s actually a perfect fit.  We’ve got people who understand how to deliver great services to patients and their healthcare providers.  We’ve got people who understand how to run such services internally.  We’ve got an IT team to deliver the software that’s necessary for patients, their healthcare providers, and our internal team.  What they don’t have is an understanding of the overall user experience for each of the different types of people who use our system and services.

On the other hand, I don’t exactly fit in with my direct team, who are all very focused on business and operations.  I don’t exactly fit in with the IT team either, who are very focused on delivering a solution to my team.  I’m the one who’s tasked with understanding the experience of everyone who comes in contact with our system and services, and ensuring that we’re delivering the right user experience for each of those groups.  Patients have different needs than healthcare providers, and both have different needs to our various internal users.

From a UX perspective, this all makes perfect sense.  As a UX professional, it’s my job to understand not just what people do (or don’t do) with our software and services, but the context in which they do it.  I have to understand what they’re really trying to accomplish, and what else they’re using to accomplish it, what works and what doesn’t about their current method, and design a solution that meets their needs.

I’ve spent my time so far getting up-to-speed on Genentech and Access Solutions: what we do, how we do it, who interacts with us.  I’ve spent some time in the offices of healthcare providers, talking to everyone from doctors to nurses to office managers to front office staff to billing managers.  I’ve learned so much in the past few months.  It’s been amazing.  And I’ve shared what I’ve learnt with my team, to help them see our services through the lens of UX, and to consider ways we can better meet the needs of our patients.

I get to use my UX skills in a way that we often don’t get to.  It’s been fun, it’s been eye-opening, and I have high hopes for the future.  But I also don’t have a built-in UX community that I can turn to.

And then I got to meet the US Digital Service team and hear about projects that they’ve worked on, and suddenly I realized that I’d found my people.  They understood the challenges of doing UX in an organization that hasn’t exactly considered UX before.  They understood the challenges of doing UX in an organization that has deep ties to processes and technology that are often considered outdated elsewhere.  They understood the challenges of communicating about UX in an organization that knows they’re missing something but isn’t quite sure what it is. And they understood how deeply satisfying it is to improve the UX of something that is used by people not because they want to, but because they have a very different driver behind their usage.

There are other UX people out there who are trying to do the same thing that I’m doing.  It was a great feeling.  I’ve already had coffee with a couple of people that I met that night, and it was so exciting to have found my community again.  Thank you, US Digital Service.  You’re doing awesome work.  I can’t wait to share with you the results of what I’ve been doing.

Susan Kare on design

“What Every Young Designer Should Know, From Legendary Apple Designer Susan Kare”:

“People say graphic design is so different now, because you have so many more pixels and colors to work with,” Kare says. “But when you study art history, you see there’s just nothing new under the sun. Mosaics and needlework, it’s all analogous to pixel and bitmap art. And with it all, good design’s not about what medium you’re working in, it’s about thinking hard about what you want to do and what you have to work with before you start.”

you say goodbye, I say hello

In saying goodbye to VMware, I decided to say hello to a new adventure.  As of last Monday, I started a new role at Genentech.

In some respects, Genentech and VMware have a lot in common.  Unless you directly work with one of the two companies, you might not have heard of them, but they’re doing important work behind the scenes.  VMware is the foundation of the datacenters and the clouds of many Fortune 500 companies.  Genentech scientists research treatments for diseases.  If you have been prescribed one of the treatments that we make, just like you might not know what software forms the cloud for your company or what is in your bank’s datacenter, you might not look up the name of the company that makes a medical treatment.

At Genentech, I’m working on Access Solutions, which offers coverage and reimbursement support services for patients and health care professionals.  I’m here to understand and improve the user experience of Access Solutions.  I’m a week and two days in to this new role, and I’m only beginning to understand the complexity of what I’ve undertaken.

Why am I here?  The answer is twofold.  First, this role scares me.  It’s very different in every way possible from working on software.  Taking a role like this that scares me is an excellent way to get out of my comfort zone, apply my skills in a new area, and stretch my abilities.  Second, as someone with degrees in computer science and math who has spent 15 years working on software, it’s not often that you get this kind of opportunity to make a material impact on the lives of people when they need all the support that they can get.  I couldn’t turn this chance down.  And so, here I am, sitting in Genentech’s US headquarters in South San Francisco.

I don’t know where this role will take me.  I can’t wait to find out.

Q&A: moving from technical writing to user experience

I got the following question this week:

I am a technical writer with experience in usability. I do not have a professional degree in design to support my credentials as a UX professional. Is it feasible for someone who is from non-design background to even to get a portfolio considered by the prospective employers?

This is somewhat similar to a question that I answered earlier about moving from engineering to user experience.  In short, it boils down to how you discuss your work to highlight the user experience work that you have done as a part of your technical writing role.

It is certainly possible to get your portfolio reviewed. Your portfolio should show how you have applied your experience and expertise to the problem domain at hand. I recently wrote about what a UX portfolio should contain.  Technical writing can have overlap with UX. It depends on the writer and their experience. Some writers simply interview subject-matter experts and turn that into documentation. Others do much more. Your portfolio will have to explain how your work shows that you understand user experience and user-centred design.

The most important thing to do is to read the job description to determine whether it is one for which you think you would be a good fit.  Then, write a cover letter and resume/CV that explain to the hiring manager why you would be a good fit.  Focus on your UX achievements and accomplishments.  You don’t need to have a specific background to be great in UX.  You do need to be able to explain how your background will make you a great fit for the UX position you want.

BP and college students have something in common

When I was working at Microsoft, I had the opportunity to observe research that one of my colleagues conducted about how college students used Word.  During a focus group, while discussing writing papers, the students discussed methods that they used to get around a page-length requirement.  I’d heard of most of them: changing the font, changing the margins, changing the line spacing.1

I was amused to read that BP’s lawyers have resorted to the same methods.  This is quote from the judge’s ruling:

BP’s counsel filed a brief that, at first blush, appeared just within the 35-page limit. A closer study reveals that BP’s counsel abused the page limit by reducing the line spacing to slightly less than double-spaced. As a result, BP exceeded the (already enlarged) page limit by roughly six pages.

The Court should not have to waste its time policing such simple rules — particularly in a case as massive and complex as this. … Counsel’s tactic would not be appropriate for a college term paper. It certainly is not appropriate here.

It occurs to me that I hope that I haven’t given anyone any new ideas about how to get around page limits by writing this.

  1.  I recall one that was new to me: changing the font (or font size) of just the periods: professors who checked for correct fonts and font sizes usually wouldn’t bother checking to ensure that the correct font was used on every single character in the document, and the difference of a point or two of font size on a period wasn’t visually noticeable.  If you were close to, but not quite at, the minimum required page limit, increasing your period size could be enough to get you over the line.


I noticed that the official VMware tweets about their Q&A with me talk about “the inspiration behind my work”.  They got my inspiration to get started in computing, which isn’t the same as what inspires my day-to-day work.

I like solving hard problems.  The hardest problems aren’t necessarily in the code.  They’re the ones that keep people from getting to that code, or that keep that code from being something that people want to put to use.

My inspiration is seeing someone get frustrated because they can’t do something.  My inspiration is seeing someone spend hours searching online for help.  My inspiration is seeing someone trip over something, not even notice it because they always trip over it, and continuing on with that little bit of lingering annoyance that they can’t identify because they didn’t notice it when it happened.

My inspiration lies in coming up with ways that make people’s lives better.  It might be a little thing, like fixing that thing that trips them up every day but that they don’t notice.  It might be something bigger, like giving them the tools to do something that they never knew was possible but can make their days go so much smoother.  It might be in providing great APIs so that they can roll their own solution that perfectly meets their needs, and in them having the satisfaction of a job well done as they roll their own solution.

My work is invisible.  When it’s done well, you’ll never see it.  My inspiration is in keeping your life ticking along, making things easier for you, without you ever even knowing about it.

what’s next?

I recently conducted research which revealed that we had failed to consider one of the most important questions for our users: what’s next?  During the research, users successfully got through each individual step.  When it was time to transition to the next step, they couldn’t figure out what to do.  They knew what their end goal was, they couldn’t figure out how to get there.  One of my recommendations to the team is to consider how we will guide the user through the whole process so that people can accomplish what they set out to do.

When we develop applications, we break workflows up into features, and we often break up features into smaller pieces.  This process helps us build software.  It’s very easy for this process to make its way into the interaction design process: we design part of a workflow, and forget to design the glue between the individual parts of the workflow that turns it from a string of features into a workflow that helps users accomplish their goal.

Laura Klein looked at this problem from the other direction: coming up with an idea to improve your product, and then watching it get bigger and bigger as you consider what happens next.  Nothing exists in a vacuum.  There is always something that happens next.  A successful product considers what happens next, and sets its users up for success in getting to that next step and accomplishing what they really want to accomplish.

Q&A: UX portfolios

I recently was asked by a student what they should put in their UX portfolio.

This is closely related to the question about UX interviews.  Many UX interviews, both research and design, start with a portfolio review.

For a research portfolio review, I want the researcher to answer the following questions about a project that they worked on:

  • What were the research goals of the project?
  • How did they determine the research goals of the project?
  • How did they select the research method that they did?  (Note that “we were told to do a usability study” is a completely valid answer to this question.)
  • What did they learn in the course of doing their research?
  • How did they share the results of their research with the team?
  • What questions were raised by other stakeholders about the research or the results?
  • What action was taken based on the research?
  • Throughout the research process, who did they communicate with, and how?
  • Looking back on the project, what would they do differently, and why?

For a design portfolio review, I look to answer similar questions:

  • What was the user need that the designer was trying to meet?
  • What design ideas did they try as they went through their design process?
  • How, and from whom, did they gather feedback about their designs?
  • What changes did they make to the design as the project progressed?
  • Throughout the design process, who did they communicate with, and how?
  • How did they share their designs with others?
  • What design trade-offs were made?
  • What is the difference between the design and what was delivered?  Why do those differences exist?
  • Looking back on the project, what would you do differently, and why?

These questions scale to the experience of the researcher or designer.  For a student who has limited experience, perhaps working on a project for a semester that might not ever get delivered, will answer these questions differently.  They might not even have answers to some of these questions.  For someone with a lot of experience, I’m much more interested in how they balanced trade-offs, communicated their design, and ensured that their design got delivered.

I’m not necessarily looking for a beautiful design or world-changing research.  When evaluating a candidate’s portfolio, I’m most interested in how their work fit into the work of the rest of their team and how they worked with the team.  Creating beautiful designs that never get shipped is not the mark of a great designer.  Conducting amazing research that never gets acted upon is not the mark of a great researcher.  Being great at user experience is about the user experience that actually gets into users’ hands.  As Steve Jobs said, real artists ship.

the power of “thank you”

User researchers are always asking for favors of people.  It’s the nature of research.  You’re asking your design team to help you get prepared for the research, often creating or helping to create the materials that you’ll use in your research.  You’re asking your participants to give up some of their time to be poked and prodded by you1.  You’re asking your application team to make changes to their plans based on what you’ve learned in your research.  It can make a user researcher feel like they’re always taking and never giving.  It’s not true, of course: your work gives your designers and application team better insight, which results in a better product for your users.

I know that I’m asking a lot from many other people as I do my work.  As I’m doing so, I remember to thank them for their work.  I thank my participants for taking the time to talk with me.  I thank the design team for working with me and ensuring that we had the right design artifacts to share with study participants.  I thank the application team for helping me understand what they need to know, what they have time to implement, and how my work fits into their development cycle.  I thank everyone for being involved with the work, for sharing their thoughts and ideas, for listening to what we learned and asking questions to clarify points, and for sharing their thoughts and ideas for how we move forward.

Remembering these simple courtesies helps smooth the way for a user researcher.

  1. Figuratively, not literally.