This goes to eleven: the bus driver’s many interfaces

eleven devices, with eleven screens, around the bus driver's seat
I snapped this pic in the transfer bus from central Stockholm to the ferry terminal (click to see a larger image).
I counted to ten different screens around the driver’s seat. Nine were special devices, mounted to the dashboard: the GPS, radio, ticket machine, credit card terminal, communication system, route and timetable status tracker … An eleventh device – a reader for travel cards – was a little bit to the right. It’s primarily used by the passengers, but I saw the driver helping some passengers interact with that too.

You immediately see that every screen is different: full four-color LED, black and white, monochrome green, a single line of LCD characters. Each device has a its own control mechanisms – physical buttons, or virtual buttons on a touch screen, or both.

So the driver has to interact with each device/system in a different way. There’s obviously a lot to learn and remember for the driver here.

Bus driver interactiong with the devices

As Kadir at envision observed recently:

”Just a short while ago it was normal for people to have very few interactions with machines throughout the day. They used them at their jobs, and they were properly instructed. If the machine had its quirks, people knew how to work around them, they adapted to the machine, no problem. Fast forward to today and the world has changed. We are interacting with machines all day long, at home, when driving, parking, getting a snack, buying groceries. You are using a machine to read this text and depending on your definition of machine, you probably have more than a hundred of them working on the machine you are reading this text with. People adapting to machines was manageable when they operated one of them every day. Today that’s not an option anymore. That’s why User Experience Design as a field is rising in importance.”
(Why Bad User Experience Will Kill Your Product, May 30, 2013. My emphasis added.)

I’d just add one thing to that: unfortunately, it’s not at all sure that a product with bad UX will be killed – if it’s something we have to use at work. The bus driver can’t really refuse using any of these devices, or replace it – even if hates it. And he/she often has little influence over the company’s decision what system to use.

This is the digital workplace of today. Whether you’re in a bus, in the office, in a shop … we all have to master a multitude of systems.

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”Workplace Tetris”

Figure trying to catch falling Tetris blocks with text like CRM, ERP, CMS, Word etc
Fun metaphor from a great talk by @oscarberg of The Content Economy, given at Intranatverk, the intranet conference in Gothenburg (May 21, 2013).

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My keynote from Booster

This is my opening keynote from the great Booster conference in Bergen, Norway earlier this month.
My focus here is to encourage developers to take on the often stupid enterprise systems that we have to use in the workplace. And I also want Scandinavian designers to build upon the heritage and tradition of ”Scandinavian design”, with the democratic design ideals and focus on simplicity, minimalism, functionality. Those guiding principles are exceptionally well suited in a digital world.

Link to Vimeo: Get up from your chair, get digital! – Jonas Söderström’s opening keynote. You can grab the slides for ”Get off that chair, get digital” from Speakerdeck.

And please note! There are lots of other great talks at Booster’s Vimeo site. Do have a look!

Thanks to the Booster team for a truly great conference!

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Just like House – but with real-world IT

Q: How can you tell House, M.D. is fiction?
A: They never have problems with their EMR or other IT systems.

* * *

The following reads just like the script for an episode of House. But it’s for real:

”The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.
‘Get me out of here!’ the man shouted from his hospital bed. ‘They are coming to get me. I gotta get out of here!’
His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.
For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. ‘What the hell is going on with my brother?’ she demanded.”

Every month, the Diagnosis column of The New York Times Magazine publishes a real case, and challenges its’ readers to find the correct diagnosis. In Think Like a Doctor: A Confused and Terrified Patient (Feb 7, 2013) the readers learned about a a 55-year-old man well on his way to recovering from a series of illnesses, that suddenly became confused and paranoid.

What’s special is that NYT Magazine provides us with all the actual medical notes, labs and imaging results (with real names omitted). All in all, there are 40 pages that the readers are invited to browse on documentcloud.org (click the image).
bild på fallets medicinska  dokumentation

Having examined the case, several readers found the solution to the mystery: excess levels of the neurotransmitter serotonin, caused by a near-fatal combination of medications from the hospital, from the rehab facility and others.

But what’s interesting to us is the conclusion the column’s writer, M.D. Lisa Sanders, makes when presenting the solution of the case:

”Electronic medical records were supposed to help solve this problem [communication about medications, my note] but it seems they more frequently focus on the kind of information essential for billing so that, whatever problem the patient has, the hospital or facility gets paid. By providing too much information that isn’t medically useful, and not enough that is, electronic medical records are just one more barrier to good health care, one more red herring in the pursuit of a correct diagnosis.
(A Confused and Terrified Patient Solved, NY Times, Feb 8, 2013)

So EMR and EHr software, in its current form, instead made a problem they were supposed to help with more difficult.
”The comments about EMR not helping are certainly on target”, one physician wrote in the comments section. ”Over-medication with dangerous drugs is the other half if the problem. Drugs that are pushed by big pharma, in order to make money. Our docs need to learn to be a little more skeptical before adding more and more meds for every patient they see!” says another.

bild på piller som lagts ut i form av en liten människofigur

Avoiding unwanted drug interactions is now a main selling point (pushed by IT companies) for introducing even more IT systems in health care. Companies typically claim that harmful combinations of medications will be detected, auto-magically.
This might sound good at first. But so far, the IT industry has not really made good on many promises of fantastic effects of their IT health care systems. Plus, to me more IT would be an expensive way of not fixing what is actually the problem: over-medication. So first we pay money to Big Pharma for too many pills; then more money to Big IT for fixing the symptoms (and conserving the problem).

But what about the patient, then? Well, like in a good episode of House, he recovered and is neither depressed or distressed any more.
The health care sector, though is still in distress. That’s depressing.

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Hey, startups: bad enterprise software is there for you to fix

Yongfook, entrepreneur based in Singapore, encourages startups to take on the challenges of enterprise software:

”Every day, hundreds of millions of people go to work and hate the piece of shit software they have to use to perform their jobs.

Every day, thousands of startups are trying to make it easier for people to share 6-second video clips or bookmark photos of cats.

There is a world of enterprise software companies that modern startups are completely oblivious to. These enterprise software companies are making millions of dollars building the kind of technology solutions that the average startup would laugh at. It’s time this changed.
Enterprise

But yongfook’s most important point is this:

”As a startup, your primary goal is to survive. How long until you break even? B2C makes money at scale and through experimenting with different business models – it’s not for the faint-hearted or the low-of-funds.

Your payday will come much sooner and more predictably if you focus on fixing one of the infinite problems that businesses have.
Big, medium, small companies – take your pick.
They are all riddled with problems to solve.

And indeed – when you, for example, find that Springtime’s list of Top 10 business ideas & opportunities for 2013 puts a coathanger for fashion stores that displays the number of Facebook likes for that item at the top of the list, you sort of think – surely we can do better than that?

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New chores hit self-esteem in doctors

What causes stress in the workplace? Too many things to do?

Not necessarily, a seminal Swedish study shows. The important factor is if you consider your tasks purposeful and fair.

In the study, more than 1500 physicians were surveyed twice. First, they rated to which extent they had to perform what they considered unnecessary and unreasonable tasks. The doctors answered questions like ”Do you have to do tasks, that you really think need not be done at all? Do you have tasks that you think should be done by another person or profession? Or, that puts you in uncomfortable situations?”

In a second survey, the same group answered questions about stress, anxiety and mental exhaustion.
The results showed ”an increase in risk that is rarely shown in occupational studies”, the researchers say.

Stress-related cognitive problem were almost five times more frequent in the group with high levels of ”chores” – unnecessary and unreasonable tasks: 29 percent compared with 6 percent among those with low levels of illegitimate tasks.
More than 50 percent in that group reported that they often were totally exhausted at the end of the workday and 37 percent felt that they often were near the limit of what they could manage.
The study was carried out at Stockholm University, and published in the Swedish Medical Association’s journal Läkartidningen in November 2012.

Recent years have seen an explosion of new administrative tasks in many professions. Ever increasing demands for detailed documentation of every step is one common factor. And new IT systems have made cutbacks on administrative specialists possible; instead various so-called ”self-service solutions” have been introduced.

But such internal, administrative IT systems are generally reported as having low usability, with scores of unnecessary clicks, and structures that are hard to understand. Doctors, as well as teachers, social workers, even policemen, now complain that this is turning them into part- or full-time administrators – spending time with the computer instead of with the patients, fighting arcane IT systems in the office instead of crime on the streets.

The point is that chores, like administrative work with no real sense of purpose, hit the individual’s self-image. Am I a doctor – or a data technician? To maintain a good self-image is seen as a fundamental human need, why stressors that constitutes an attack on the self are assumed to have strong effects.

In responses to another survey from the American EHR partners, physicians commented that electronic health records requires a lot of extra work, with a low sense of purpose: ”Many systems require you to at least click through a variety of screens if only to accept their entries.” ”… has added multiple lists I need to click through, including re-affirming all office visits even after I dictate.” ”Pages and pages of repetitive nonsense”.

The benefits from this new way of work may, the Swedish study suggest, come at a very high cost.

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UX Podcast about ”Stupid bloody system!”

Per Axbom, James Royal Lawson and me talking about poorly designed digital systems and the work related stress this causes. Where did it all go wrong? How do we fix it? Can we fix it?

Listen to it here: Episode 32: James and Per scream – Stupid bloody system!.

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Overworked from Electronich Health Records (EHR)

utdrag från EHR-bloggen
American EHR Partners notes that Electronic Health/Medical Records (EHR/EMR) means much more work for physicians. In clinics that have implemented an EHR, doctors often spend considerable time working after-hours in the clinic, or at home in the evenings.

This feedback is not limited to specific EHRs but tends to be a more general issue. The following comments were among those submitted by physicians who completed AmericanEHR Partners’ survey on EHR satisfaction:

  • ”I can get through my day, but I spend an extra hour to two hours longer at the office than I used to prior to our implementation of the EHR. This is really bothersome to me.”
  • ”It makes a 15-minute visit take 2–3 times as long. I’m not sure I’ll everbe able to get back to my pre-EMR volume. Some nights, if I have a meeting after work, I’m up working on charts until 1 am! And that’s only working at 80% of my previous patient volume! There has to be a better way… talk about burnout.”
  • ”Radiology reports are now coming across through an interface, but we are unable to see images — for this we must log onto a remote desktop for the hospital in a separate application. I am routinely having to finish charts at home after work.

Has EHR Increased Your After-Hours Workload?
(9 nov 2012)

The comments for the blog post are unequivocal. By prescribing a very specific way of work in every case, EHRs both waste time and produce so much trivial and redundant information that the critical parts becomes very hard to find:

  • ”I consider it extremely important to choose an EMR system that does not require a specific work-flow to produce each chart note. Not all visits require a review of Family History, for example. However, many systems require you to at least click through a variety of screens if only to accept their entries.”
  • ”I certainly feel that this is the case. (I am finishing some up this weekend!) Meaningful use has added multiple lists I need to click through, including re-affirming all office visits even after I dictate.”
  • ”Pages and pages of repetitive nonsense and the actual life saving information is not there! We are aproaching the EHR tower of Babylon, where communication is impossible.”

Some even long for the paper days:

”Occasionally we have a patient come to the office from the pre-EHR (3 yrs ago) days. For them, we are first handed the old paper chart from the back room files before beginning their note.
What a difference! The paper charts were simple, accurate, quick, and streamlined. All the things the behemoth “Practice Partner” system claimed to be. I long for the days of the paper chart.
The sad fact is that EMR in its present state is inefficient, dangerous, and uses 3 times more paper than our paper system ever did. It is the perfect example of what happens to a system when it is overtaken by bureaucrats and self-serving paper pushers.”

See also: Swedish study links doctors’ stress to ”unnecessary and unreasonable tasks”

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My talk at Euro IA 2012

Now with full and corrected speaker’s notes.

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New edition of ”The design of everyday things” in August

Donald Norman just tweeted: ”Design of Everyday Things, Revised now on track. Pub date August. Same length but w/ new examples, HCD methods, signifiers – eBook in color.”
Cool! ”Signifiers” is what Norman now prefers instead of ”affordances”, the term introduced in the original The Design of Everyday Things in 1988 (or, in fact, The Psychology of Everyday Things, as it was first called).

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