In their forecasting workshops, the Institute for the Future trains practitioners to sensitize themselves to “signals,” something that may seem banal but on reflection foretells great change or deep meaning. That story about the arctic penguins who accepted a furry remote controlled camera as a chick is one of mine. Still wrestling with its implications. This interface is another.
After Joe walks past the FloorMaster and Insurance Slot Machines, he finally makes it up to the triage desk. It’s labeled CHECK-IN, and the sign devotes a large portion of its space to advertising. He speaks to the employee there, named Biggiez, who blankly listens to him talk about how he’s feeling. As he talks, she looks down at a wide panel of buttons, floating her pointing finger above the unlabeled icons that kind-of describe common ailments.
When Joe says, “I don’t even know where I am,” she finally pushes an icon featuring a stick figure, shrugging, with two question marks floating in the space beside its sad face. In response, it lights up, we hear a ding, and a SMARTSPEEK device on Biggiez’ blouse says, “Please proceed to the diagnostic area on the right…and have a healthy day.” Joe moves on to the diagnosis bay, which I’ll discuss in the next post.
A shout-out to these icons
While I normally stick to the canon of what actually appears in the final edit, these are hilarious, and the designer has published the lot of them online, so feast your sense of humor on the whole smörgåsbord.
Behold them. They are, literally, 9 kinds of funny.
- Some are slapstick. Squirting hole in butt cheek. Hole in gut. Ow, my balls.
- Some point to the stupidity of the patients. Baby drop. Things-what-damaged-my-head (lightning, knife, nail, gun, bump). All the evisceration.
- Some point to the stupidity of the maker of the panel. Options for gender include and are limited to (rather than, say, the much more reasonable 63:
- I cannot tell. (Alternately: They are feeling gender dysphoria.)
- They are hermaphroditic/intersexed.
- They are a female to male transsexual.
- Some point to not-hospital problems. Feeling angry.
- Some point to not-problems. Thinking of atoms. I recycled.
- Some are nigh-impossible. Hello, I am dead by decapitation. Have I drowned? I am in such pain that I have gained a third eye.
- Some show how slipshod the QA on this thing was. Two left/right arrows (when there’s nothing), two guns-to-head
- Unhelpful nuance. My arm is chopped off. My leg is chopped off. My scalp, arm, and lower leg are chopped off.
- Some are inscrutable. An asterisk. A takete (with no baluba). Updown.
That’s graphics carrying quite a bit of comedy load here. Readers interested in behind-the-scenes will like to know they were made by designer Ellen Lampl. (A significant portion of her portfolio is film graphics, so be sure to check it out.) In 2014 she had an interview with Phil Edwards which you can read on triviahappy.com, where she tells more about her process.
The set is even funnier because of course how could the breadth of human problems be reduced down to 48? (And these 48.) There are 14,400 codes in IDC-10 alone. What is Biggiez supposed to do if Joe was complaining about being struck by duck? IDC can handle that. (No really.)
But aside from praising the comedy, let me do my due diligence and discuss four (off the top of my head) improvements that could be made if this was a real system. Even for morons.
How about labels?
Yeah. Not a single one of them are labeled, introducing way too much ambiguity. Labels don’t always provide the specificity they need, but not having them on icons practically assures it.
Allow multiple ailments
Another failing of the panel is that is doesn’t appear to handle multiple ailments. In fact, Joe complains about hallucinations (R443), a headache (R51), and aching joints (need some help with that one, but her finger is so close to the knee icon), but she only indicates the one about confusion. You’d hope there was some way for her to touch an icon for every ailment, and then submit them but that just doesn’t seem to be the case. Maybe patients just have to keep coming back to check-in to care of each thing, one at a time.
The purpose of triage is first to rank the urgency of the need medical care. The gal with the baby dropping needs to be seen now, but the gal who just has some questions can wait over there for a while. How would this panel code urgency?
Urgency might be just part of the code (gun to head less than knife buried in head), but that would mean this panel would have to have separate icons for light scratch to the scalp and a gaping free flowing head wound, and they just don’t require the same levels of attention.
The panel seems to have a simple pain scale on the left of [happy | sad | neutral], but since Biggiez doesn’t touch them, it’s not clear that these work like a chorded button or some separate code for someone who comes in complaining about their base emotional state.
A better system would let you identify the problem and pain scale separately, as different facets of the complaint.
Just to make sure I’m saying the 101 layout principle: if you really had a panel of flat options, chunking them into groups helps the user understand, recall, and find items.
This points to an opportunity
So of course there are lots of reasons why this is funny as hell, breaking lots of fundamentals for a funny, body-horror kind of joke while Joe figures things out.
But I think the reason this interface has really stuck with me is that it would pass a usability test. As in, Biggiez finds it perfectly easy to use. She can scan the icons, tell them apart, select one with ease. Hell, the SMARTSPEEK even makes sure she can’t mess up telling the patient what to do next. This would get a very high Net Promoter Score. It would do well on any self-reporting satisfaction measure. And it still sucks.
Sure, it would fail an efficacy test, but what if we took on the hubris of rethinking the role of the interface here. To the point, this interface lets Biggiez just stay dumb. (And we have way too much of that in the world as it is.) What if it could make Biggiez smarter?
First draft: What if two nurses listened to the patient’s complaints side-by-side, and their codings were only revealed to each other when they’d both completed them. Then, as the patient went through diagnosis, a fedback loop rewarded the nurse who was most correct. The reward could be money, or rankings amongst peers, or almost anything really? Biggiez would have incentives to not just do the task (or have the task done for her.) She would have incentives to get better and smarter at her job.
This may not be the best actual design proposal, but I’m intrigued by this possibility. What if our interfaces could make everyone who used them smarter? Faster? Stronger? (Musical break.) What if every technology was like this? With technology everywhere, what if technology made us better instead of treated us like petri dishes for colonizing?
I am thinking about it.
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Though I appreciate the motive behind your two nurses idea at the end, I think that could quickly devolve into some behavior that’s unhealthy–for both nurses and patients alike. It seems like it might encourage competition or cause reduced response times as nurses are now too afraid of making a small mistake in their diagnosis. I’m all about technology making people smarter; I’m also very nervous about turning peoples’ lives into games.
It’s a fair point. But it’s also true that this interface isn’t helping her. What’s another idea for how we could improve it?
Thinking about it more, I think the feedback during diagnosis is a great idea for helping the nurse to improve without attaching any kind of monetary or other reward to it. Maybe have it be part of a yearly review process?
The problem I see is that the two nurses will know when they entered different data, but won’t receive any actual feedback until some time later. In the immediate short term, all they can do is worry that they might have screwed up. And when they eventually do get feedback, hours? days? weeks? later most likely they will have forgotten exactly why they made the choices they did, so it won’t be helpful.
I’d suggest the two nurses compare their entries, and have time to talk about it, make changes, and submit one final coding. There would still be the risk of a more experience or more forceful nurse pressuring the other into agreeing with them, but being an optimist I like to think that most of the time two heads are better than one.
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…what was the “Musical Break” link/URL to? It’s not longer available at the link that was posted.
Given the context it was almost certainly Daft Punk’s “Harder, Better, Faster, Stronger.” It’s gone from YouTube, but still on Spotify… https://open.spotify.com/track/5W3cjX2J3tjhG8zb6u0qHn?si=72e2976d4152440e
…oic, thanks for the reply.