CHI-WEB Archives

ACM SIGCHI WWW Human Factors (Open Discussion)


Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Condense Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
"ACM SIGCHI WWW Human Factors (Open Discussion)" <[log in to unmask]>
Wed, 13 Jan 2010 16:09:33 -0500
Tim Shea <[log in to unmask]>
text/plain; charset="UTF-8"
Tim Shea <[log in to unmask]>
text/plain (77 lines)
Hi Hal: 

One of my favorite books on health care is "Better: A Surgeon's Notes on Performance" by Atul Gawande. There are several fascinating chapters, for example "On Washing Hands" covers the human-factors issues associated with the (seemingly) prosaic topic of hand-washing, and the significant impact this has on patient mortality. 

Dr. Gawande writes frequently for The New Yorker. In one article (mostly on health care costs) he describes the patient-centered approach of the Mayo Clinic. See this link: . A quote:


The physician spent an hour with her, sorting things out. He phoned a cardiologist with a question. “I’ll be there,” the cardiologist said. Fifteen minutes later, he was. They mulled over everything together. The cardiologist adjusted a medication, and said that no further testing was needed. He cleared the patient for surgery, and the operating room gave her a slot the next day.

The whole interaction was astonishing to me. Just having the cardiologist pop down to see the patient with the surgeon would be unimaginable at my hospital. The time required wouldn’t pay. The time required just to organize the system wouldn’t pay. The core tenet of the Mayo Clinic is “The needs of the patient come first”—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients."


I spent about a month in an ICU at a top-ranked hospital caring for a family member a few years ago and the gaps in continuity of patient care astonished me. Different nurses every day meant no one was truly familiar with daily (and often subtle) changes in patient state. Things dropped through the cracks. The family was the only real source of continuity that I saw. Doctors rotated in and out, some were neglectful, others caring. Some nurses were competent, others struggled (often unsuccessfully) with complex equipment when not eating donuts in the nurses' station, and the assignments were different every day. The difference in patient response between nurses was obvious. One of the most dedicated nurses I've had the privilege to know recommends the book "Bed Number Ten", written by a patient with Guillain-Barre syndrome. An excellent book for care-givers, but really about nursing (and empathy) more than human factors.


-----Original Message-----
From: ACM SIGCHI WWW Human Factors (Open Discussion) [mailto:[log in to unmask]] On Behalf Of Stephanie Barone
Sent: Tuesday, January 12, 2010 8:43 AM
To: [log in to unmask]
Subject: Re: [CHI-WEB] Patient-centered medicine & user-centered design

I am a webmaster for a regional hospital. We use the Relationship-Based Care approach to provide patient-centered care - which basically means you have a nurse assigned to you for the length of your stay. One nurse who will be familiar with you, your condition, and your family. 

Our organization is the first to include Support Services in their endeavor. I obviously don't care for patients directly. But I do try to provide the information they need, when they need it. 

I love your idea of applying UX approaches to our push for primary nursing, and look forward to hearing more ideas.

Stephanie Barone
Web Developer / Producer
Communications & Marketing at Faxton St Lukes Healthcare
(315) 624-5280 
[log in to unmask]

>>> Hal Shubin <[log in to unmask]> 1/11/2010 2:38 PM >>>
I was talking with my primary care physician today about how un-patient-centered my recent hospital stay was. (See below for some examples.) He mentioned a seminar or class he teaches for residents about empathy and looking at medical care from the patient's point of view. I'm so glad he mentioned this because the experience made me want to find a way to apply what I know to fix the problem.

I'm sure there's not a lot of medical literature about this. Driving away, I started thinking about what there is in *our* literature, and in our methodologies that could help him. For example, maybe the idea of personas would be useful: they could work together to create personas for Sally SeniorCitizen, Andy Appendicitis, Uncle UnknownProblems and Polly Pregnant, and refer to them in their discussions.

Some of my consulting work has involved medical software and hardware, and I've done usability testing with physicians. But this is different. Have you done anything relevant that I could pass along? Or have any ideas that seem appropriate? 

thanks-- hs

A few examples of how un-patient-focused my hospital stay was. 
= I didn't mind having vitals checked every four hours around the clock -- it seems useful, and I wasn't sleeping well anyway.
= Nurses would do something and say they'd be back in (say) 20 minutes to check on the outcome, but it was much longer than that.
= Someone came in during the night and started asking questions without identifying himself -- how do I answer without knowing who and what he is? 
= Two teams of doctors wanted to poke, probe and interview me when I was just too cold and uncomfortable, so I had to ask them to leave. They said they'd be back soon, but it was the next day. 
= Another doctor wouldn't tell me what I should order when I was moved to a solid diet, he just vetoed all my suggestions; he said he'd come back later instead of helping me right then, but he sent a medical student three hours later. Etc.

- - - - - - - - - -
Hal Shubin  -  Interaction Design, Inc.
617 489 6595  -

           Tip of the Day: Postings must be in plain text
     CHI-WEB: POSTINGS: mailto:[log in to unmask]
              MODERATORS: mailto:[log in to unmask]

    Tip of the Day: Use the archives to research common questions
     CHI-WEB: POSTINGS: mailto:[log in to unmask]
              MODERATORS: mailto:[log in to unmask]