Applying UCD to Healthcare

As mentioned, the most relevant situation for UCD is one where a change in user behavior is required. This is accomplished through a deep understanding of current behaviors, which informs an innovation design that is very easy for the user to engage with.

By designing innovations that accommodate for a user's current behavior, our innovations become much easier to use, and/or much more compelling to users, which makes changes in behavior much more likely. There are few contexts where changing behavior is more urgent or relevant than in the healthcare system, where changing behavior can be literally a matter of life and death.

In this final section, we will consider several cases of innovation initiatives in the healthcare context where user behavior was or was not successfully changed, and where UCD was or was not employed. Consider the following matrix:

If UCD does in fact improve the impact of innovation initiatives in healthcare, we would expect that examples that fit quadrants I and III would be easy to find, and indeed they are. A great number of examples exist in the realm of software solutions, where UCD was not employed, and the result was abject failure.

Enterprise software solutions have repeatedly failed to penetrate the health care field, mainly because of a failure to understand the behavior of healthcare providers. Expert systems, for example, which failed to acknowledge the centrality of human judgment to the training and the practice of a physician, expected physicians to embrace and execute on "best practices." Electronic Health Record (EHR) systems have also sputtered through the last 50 years, achieving around a 30% penetration rate in that time, and that only after the federal government imposed penalties for not adopting.

Contrast these failures with the work happening at Children's Hospital Boston, where surgeons in the world renowned pediatric cardiac unit there have developed a system that publishes a "sound practice," which physicians are free to deviate from based on their own judgment, provided they track all such deviations. Rather than pressure to conform, doctors are given access to the data they are themselves generating, which allows them to see for themselves the outcomes associated with their deviations. Since sound practice is not enforced as a standard, it can be updated dynamically as better data becomes available. Sound practice, then, becomes nothing more than the articulation of how the physicians are practicing medicine, and provides an extremely high motivation for doctors to adhere to the sound practice. By reducing the variation in testing and treatment (and especially by eliminating unnecessary tests and treatment) through the hospital is able to cut costs, which they monetize via an agreement with payers called PPQI (i.e. a policy innovation where payer and provider collaborate and share the savings created.)

So far, our matrix is identifying successful and unsuccessful innovation initiatives as expected.

It is far more informative, however, to see where our hypothesis breaks down.

Take, for example, the case of Health Stop, as summarized in the article that follows.

Unfortunately for Health Stop, there was a major first mover disadvantage in entering the market for low cost health services. Health Stop was, in essence, a user-centric business model innovation: it was borne out of a desire to make the process of seeing a doctor easier for patients that either didn't have the time or couldn't afford to go to a primary care physician.

Health Stop faced competitive pressures from the local incumbents in primary care, and failed to develop the kind of brand loyalty necessary to combat the damaging messages coming from competitors. Health Stop would have had to spend significant resources on advertising and promotions to quickly build brand loyalty - resources that are difficult for a startup to spend on non-operational expenses.

It was an arms race they lost, and Minute Clinic took note, aligning their fast follower business with big name brands like Target and CVS before the competitive pressures set in.

Finally, we consider a well known example that was not UCD, and yet was a very successful innovation. When Pfizer first developed a compound that appeared to dilate blood vessels, they began development of an oral drug for angina and hypertension based on the new compound. Following the well established protocols of product innovation in the pharmaceuticals industry meant they had to move from mouse models to human clinical trials, but when they did, the drug turned out to be a dud, or so they thought.

The most fascinating part of this story is not that one of the most famous drugs in history came out of a side effect from a clinical trial for a different condition - the most fascinating thing is that Pfizer almost shut the project down, since they had spent so much and failed to prove it was useful for the original conditions, and repeating the trials now would mean millions more dollars.

It was lucky for Pfizer that so many of the users were asking for the drug, even after the trial had ended, that it was impossible to ignore. Had they ignored this user feedback at this crucial moment, millions in sunk costs, as well as billions in potential sales would have been lost.

Even in situations where a more conventional, technology-centric or R&D-centric innovation model is applied, user feedback is crucial.

Whether the focus is on product, service, process, business model or even policy innovation, the voice of the user can lead a manager down a successful path, provided they are practiced at listening to the voice of the user. In an age where the cost of reaching an audience approaches zero, the value of sustained attention and engagement grows exponentially, and consumers prefer listening to one on other rather than the voice of the brand, listening to the voice of your user is more important than ever. This is not a discipline that is aligned with the way brands and products have been managed in the past, and is a key competitive battleground for the future.