Absence of user-centric design: a threat to patient safety

Summary

As a Consultant Obstetrician and Gynaecologist, I feel privileged to have worked as a doctor in maternity and women's healthcare for the last 25 years and to be a part of a brilliant team and organisation.

Having recently read the blog 'Dangerous exclusions: The risk to patient safety of sex and gender bias' by Patient Safety Learning, I feel compelled to share my own experiences. 

Content

Many aspects presented in the Patient Safety Learning blog will resonate with staff working in healthcare.

Nurses, midwives and doctors want to provide the best possible care. At the heart of healthcare are patients. Competent professionals care for them using tools and technology, performing tasks in a particular environment. In addition to good training and patient safety culture, it makes sense to design the equipment and workflow for the users to optimise performance and well-being.

However, quite often it is evident that medical instruments and devices, as well as equipment such as operating theatre tables, have not been adequately designed in a user-centric manner, taking into consideration the variation in anthropometrics. For example, operating theatre tables and laparoscopy equipment stacks are designed for users with a height of 5'10" and above. Many hand instruments are designed for large hands.

It would be good to share a couple of photos here.

This photo shows me holding a forceps which is used to hold tissue and stop bleeding.

It is quite apparent that it has been designed for a larger hand. Smaller forceps for this purpose are often not available in the tray or must be specially ordered through a process that is not easily accessible. The organisation that I work for is quite supportive, but the entire system is not set up to enable clinicians to have tools and technology designed in a truly user-centric fashion.

The second photo shows me standing on a platform that is frequently used by short surgeons, usually female, to elevate themselves. 

This helps them operate effectively when patients are on theatre tables, that are designed for tall surgeons. This results in a shuffling act, as one would have to press the diathermy pedals during surgery time and in gowns and clogs that may be ill-fitting, never mind the risk of tripping and falling.

We are fiercely envious of tall colleagues (male and female) now and again.

Why does this matter for patient safety?

As time passes, we develop workarounds 'to get the job done'. These can be effective and functional but can cause 'error-traps' and user fatigue.

After years of juggling and acrobatics, one does develop a unique way of getting around these annoyances. On a lighter note, this workaround training may confer an advantage of reducing the risk of balance issues and dementia in later life, which is my wishful thinking.

On a serious note, it is evident that this issue can seriously compromise patient safety and process efficiency.

The role of user-centric design – how do we enable meaningful change?

Good design is difficult to notice because it enables users to effortlessly do the right thing.

A few steps that we could take to address issues like those highlighted in this blog:

• Manufacturers and software providers should follow the latest MHRA guidance on applying human factors to the iterative design process.
• NHS Trust procurement should select technology and software based on clinical evidence and user interaction (usability) reports along with the local user group collaboration.
• The Trust patient safety departments and patient safety leads can be proactive in selection of new equipment and provide feedback about existing software and technology to the manufacturers responsible.
• Increase awareness among users and managers about human-centred design and system engineering. This will help them notice and improve the tools, tasks and clinical environment to optimise care.
• Patient and public involvement can add value to parts of the system such as community and primary healthcare.
• All of the above need resources, policy, and strategic direction from NHS England and the government for a sustainable and meaningful change.

Aditi Desai