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P.S. I Love You
A charismatic leader, mind control, and other telltale signs
Photo by Drew Angerer/Getty
On October 23, 1863, when the expected apocalypse failed to occur, an estimated 100,000 followers of breakaway Christian prophet William Miller descended from their rooftops in what the mainstream media assumed would be disgrace and embarrassment. “When the world stubbornly refused to come to an end last Spring,” a condescending Pennsylvania Statesmen mused, “notwithstanding the ingenious and elegant calculations of Mr. Miller, we indulged in the hope that the whole affair would be laid on the table, or indefinitely postponed.”
But despite having sold all their worldly possessions in the belief that they would be meeting Jesus Christ and swept up to heaven, the followers were undeterred. They simply set new dates for doomsday and committed even more steadfastly to their cause. Newspapers such as the Herald Expositor considered it their responsibility to dispel “this and similar delusions,” but to no avail. As if invigorated by disappointment, Miller’s followers later went on to establish the Seventh-Day Adventist movement, now 25 million members strong.
In their increasingly patronizing coverage of Trump supporters, the editors of the New York Times and CNN are practicing the same stubborn incredulity, trooping out to Trump country every time the president is caught in another big lie to ask how the hell folks can still love this guy. But if the Trumpists’ commitment seems surprising in the wake of ever-mounting scandals, that’s because mainstream journalists still haven’t grasped the Trump phenomenon for what it is: a cult.
First, a disclaimer: This piece is not about politics but the deeper motivations of the Trump constituency, how they are reinforced, and how they reflect the higher, almost spiritual ideals informing nearly a third of Americans right now. Further, Trump is hardly the only politician to have exploited the dynamics of cults; the Clintons and Obamas also leveraged the cultish devotion of their followers.
But Trump’s particularly loyal core constituency — his ability to joke that he could shoot someone on Fifth Avenue and not lose the support of his base, or to convince surrogates to endorse an ever-changing assortment of conflicting facts — suggests a more intense, cultish loyalty than we have seen before. Even Senator Bob Corker (R-TN) has begun to use the word “cultish” in describing the GOP leadership’s fear of contradicting the president. And the boldness with which Trump scolds his detractors — especially those in his own administration — closely tracks with the behavior of those who use their charismatic power to control others.
The parallels to the cult of Trump are obvious.
I know this because I studied cults of many kinds throughout the 1990s. I first became interested in how they work after spending a year helping a family member get out of a cult, and then almost losing a girlfriend to another. I became something of an insider to both, attending many of the gurus’ meetings. I observed their behavior as well as that of their followers, who jockeyed for position through demonstrations of extreme loyalty. These guys were good at what they did, and though I knew they were charlatans, I occasionally found myself drawn into the competition for their respect. As an outsider and budding cultural anthropologist, however, I managed to codify their techniques as well as the social dynamics fueling their followings.
I went on to write a study of cults for a major advertising agency that was looking at the relationship between spiritual cults and cult brands such as Apple and Harley-Davidson. After conducting a number of focus groups with both cult members and brand superfans, I developed a standard sequence of the stages of indoctrination common to most cults — from destructive spiritual cults to more innocuous corporate affinity groups. In essence, they’re all pyramids in which members seek to get closer to the top by accepting more outlandish claims, maintaining faith in the leader, and defending him (they are almost all male) against detractors. I later published my findings as a chapter in my book Coercion: Why We Listen to What They Say.
The first technique employed to instill loyalty is to get the devotee to do or share something, anything, that’s potentially compromising or embarrassing. One cult leader asked new followers to come on stage, in front of the group, and crawl around at his feet like babies. Scientology reportedly has used members’ sexual histories as leverage against members who wish to leave. Moreover, once a person has said or done the embarrassing thing, they try to justify it after the fact: He had me act like a baby as a spiritual exercise in dropping ego. They’re using my sexual history to help me remember who I really was so I can get clear. The person is then naturally drawn to others who have done the same things, as in a fraternity hazing.
Slowly but surely, the tests of the faithful become more extreme. Cult members may be asked to quit their job, divorce their spouse, or disown a child. I observed one cult leader ask a devotee, “Would you do anything for me? Would you die for me? Would you kill for me?”
Cult leaders often demand testimonials or statements of loyalty from members, delivered in front of their peers or, better, family members who are not yet initiated. “Tell everyone here why you love me more than anyone,” one guru demanded of a bride and groom at a wedding I attended, with their nonmember parents and in-laws looking on. Later, the bride explained to me, “I realized that I wouldn’t have done that if he weren’t really God.” Divinity, retrofitted after the fact.
Trump’s followers are routinely asked to support increasingly difficult claims — or what members of mainstream consensus reality would call lies.
The other way to move up the pyramid is to demonstrate faith. Those at the top never betray the slightest bit of doubt about whatever the leader is saying or doing. Whether they mean it is a secondary matter. What’s important is vocally supporting the leader’s claims. And the more outlandish those claims, the more of your own agency and free will you give away by asserting them. Yes, the leader made himself disappear and then reappear in another room. Yes, he is correct when he says he is the one point of light from which all truth emerges. No, that was not rape but a transmission of the divine spark. (All are real claims from members of cults I studied.) The more you say it, the more true it becomes — and the less ability you retain to think for yourself.
Doubt can be expressed, but only to those higher in the pyramid. To express doubt to someone below you in the hierarchy is to be reduced to their level, or below. And if they report you, they move up. It’s a crime to instill doubt and push someone off the path. All this suppression of doubt, flamboyant demonstration of devotion, and prosecution of disloyalty is seen as necessary because the group must steel itself against its greater enemies: the conspiracy of established institutions looking to destroy it.
The parallels to the cult of Trump are obvious. For instance, anyone who has sat through the parade of testimonials at a cult dinner shouldn’t have been surprised to see Trump’s newly formed cabinet to compete to demonstrate their gratitude for being in his administration. This was the equivalent of his cult’s inner circle. With the exception of Secretary Jim Mattis, who tempered his remarks slightly, they all seemed to understand the importance of the task: to proclaim their thanks and loyalty in public, and irreversibly. One is either in or he’s out. Their professions of faith were offered up out of a desire to climb the pyramid, moving closer to the leader. Yes, it looked silly and probably felt a bit embarrassing, but that’s why the technique is so powerful. Once you’ve made such a proclamation, it’s hard to backtrack.
Trump’s followers are routinely asked to support increasingly difficult claims — or what members of mainstream consensus reality would call lies. Initially, these claims are almost innocuous: Sean Spicer gets tasked with asserting the unprecedented enormity of the inauguration crowd and with debunking the news media’s photos and tallies revealing the truth. Once he’s done so, Spicer slowly comes to justify this reality to himself: Trump’s inauguration was a big deal around the world, and the particular metrics and images the mainstream media used to measure it were cherry-picked to betray the greater reality.
But then the lies — or the alternative truths — must increase in preposterousness, until the devotee, whether that’s Nunes, Huckabee-Sanders, Kelly, or Conway, is ready to commit to anything. This document was just “leaked” by the House committee. The president did not dictate the letter about the Russia meeting. Hillary colluded with Russia to feed dirt on Trump to the FBI.
Lying for the leader — or, rather, doing what feels like lying until you later accept the error of your ways and transcend your deeply distorted view of the world — is the path to earning his respect and, ultimately, expressing his greater truth.
This reversal, like choosing the red pill in The Matrix, is a common experience among onetime doubters who eventually see the light. Black is white and white is black. As recent Trump initiate Candace Owens explained it, “I became a conservative overnight. I realized that liberals were actually the racists.” Other reversals came one after another: Climate change is a hoax, Hillary is part of a criminal global conspiracy, etc.
In any cult, the higher up you are in the pyramid, the more difficult the lies you have to maintain. But gradually, as more people move up, lies that once seemed radical become broadly accepted. Soon, they start to feel true — conventional wisdom within the cult — and acolytes’ former doubts are understood as the lies from which they have been liberated.
This gives the leader ever more latitude to assert his truth. For a cult leader I studied in New York, this meant a shift from I am not having sex with the women to I am not having sex with underage women to I didn’t get the 14-year-old pregnant to it’s ultimately not wrong for me to get a 14-year-old pregnant. For Trump, we can trace a similar trajectory from there was no collusion to it’s a witch hunt to collusion is not a crime anyway. Politicians who have already committed to the lesser lies find they must accept the more difficult ones. In for a penny, in for a pound. Failure of the administration is not an option for Republicans who have made the devil’s bargain. If the leader goes down, they go down with him. By the time they realize what’s happened, there’s no way out.
Within the cult, lying is seen as a virtue, more like Zen koans or teaching stories. “The leader was only lying to me on one level in order to teach me a deeper truth.” “The leader denied having sex with the child, because it wasn’t really ‘sex’ the way most people define it.” The virtue of lying, as insiders come to see it, is to cast doubt on the bigger lies enslaving us all.
Trump’s political career was born out of “birtherism” — the claim that Obama was not born in the United States and was therefore ineligible to be president. Trump said Obama had spent millions on the cover-up, and Trump would someday show us all the truth. And although he later, begrudgingly and half-heartedly, accepted the legitimacy of Obama’s Hawaiian birth certificate, the birther campaign was still a success because it forced people to practice doubting. Simply entertaining the possibility of a conspiracy of that magnitude trains people to question their reality. Such lies are a gateway drugs to the red pill.
What makes a cult resonate and gain traction, however, often has less to do with its own claims than its ability to leverage its members’ unarticulated anxieties.
That’s why the administration could never condemn the shooting that resulted from the pizzagate conspiracy theory (in which Democrats were said to be running an illegal slave trade through a restaurant basement). Nor can the administration wholeheartedly debunk the claim that school shootings are being staged by anti-NRA actors, or anything else from Gamergate, QAnon, Sean Hannity, or Laura Ingraham. True or not, their claims serve the cult’s greater quest to sow doubt in pursuit of a higher truth.
Any behavior is acceptable, even colluding with Russia, as long as it is directed against the cult’s real enemy: the Deep State and Mainstream Media perpetrating the illusion. It is their facade — their fake news — that all of this doubt is intended to shatter, by any means necessary. In this view, the neoliberal internationalist myth is the biggest illusion going, and it’s responsible for the repression of humanity by a hypocritical leftist elite. (Even many progressives make this argument.) The forces of political correctness attack anyone who contradicts their revisionist fiction. Heck, they’re taking down statues and monuments and calling for censorship of right-wing voices. They may as well be burning books.
Every Trump tweet is another seed of doubt in the nefarious illusion.
What makes a cult resonate and gain traction, however, often has less to do with its own claims than its ability to leverage its members’ unarticulated anxieties. There’s a chanting cult in Los Angeles that does particularly well with unemployed actors who believe the focusing rituals can get them the roles they want. One San Francisco cult I studied attracts wealthy cancer patients who long for the “mind over matter” solutions it offers.
Likewise, a cult claiming all news is fake news is understandably attractive to members of a highly mediated world where everything is recorded and nothing is forgotten. Sometimes it feels as we’re each living in our own, personalized Mueller investigation, one text message or Google search away from exposure as a pervert, racist, misogynist, or otherwise deplorable person.
The virtue of lying, as insiders come to see it, is to cast doubt on the bigger lies enslaving us all.
In such an environment, many have found salvation and escape in the form of a messiah who knows how to break down the bad story that the fake news is telling us about ourselves: This is just the lie the Deep State uses to shame us into compliance. It is not real.
Once we operate long enough in this space, we naturally come to believe there’s no way to know the truth, anymore, anyway. Traditional cults accomplish this by denying members their sleep and preaching at all times of day and night. Trump’s 24-hour news cycle puts all of America into a similarly disorienting and timeless bubble in which anything seems possible. Maybe global warming is a hoax. Or maybe they’re making it happen! We move up the ladder toward awakening by learning how to break through the facade. Eventually, those who have seen the truth will be saved, and those who have been perpetuating the lie — like crooked Hillary and George Soros — will meet their demise.
For that to happen, though, the cult needs its finale: the apocalyptic Moment of Truth, when all is revealed. This is when the Millerites stood on their rooftops waiting for the chariot to heaven, when the Jonestown cult drank the Kool-Aid, and when the Branch Davidians ended up in a standoff with the FBI.
What’s the equivalent apocalypse moment for the Cult of Trump? We may be getting there. QAnon’s theories are no longer a fringe phenomenon, and the press is being called the enemy of the people. But judgment day will likely have less to do with some action taken by Trump or his followers than their reaction to something done to them. It will comes when enough Americans have enough faith in him to truly believe that “What you’re seeing and what you’re reading is not what’s happening.” So, when Trump gets convicted of a crime, impeached, or voted out of office, core members will have plenty of reason to stick with him.
Or maybe the moment of truth will arrive when Trump simply admits the whole thing: that he’s actually been working with Russia, but not for his own gain, but because we are in a by-any-means-necessary revolution against treasonous internationalists in the Deep State. It’s the equivalent of a Buddhist awakening: We have to surrender everything. If that means the destruction of what we thought of as the American government, then so be it.
We’re not there, yet, of course. Likely because Trump himself doesn’t seem to know what he’s doing. All this comes naturally to him (which makes him no less effective). Even his erratic behavior and seemingly impulsive decisions can be justified as his natural genius. The angry guru, or the drunken master.
But of course one man’s messiah is another’s satan, just as one man’s guru is another’s charlatan. Even progressive Americans have watched enough Homeland and Oliver Stone movies to fear that almost anything we fear about our government may well be true. Even some of what Trump is saying.
Ultimately, we can all agree on one thing: At least one half of us are in a cult, being told a pack of lies and marching toward oblivion.
Host: http://TeamHuman.fm Author: Team Human, Throwing Rocks at the Google Bus, Program or Be Programmed, Present Shock, Program or Be Programmed
Member Feature Story
Healthcare Design Is About More Than Aesthetics
Better UX for doctors means better care for patients
Aug 9, 2017
Working in healthcare was something of accident for me. I never had any intentions of working in this profession — nor had I considered healthcare much of an option. Healthcare, to me, was messy, technical, scientific and full of terms and concepts I didn’t understand. I also believed I wasn’t cut out for it.
After finishing my enlistment in the Marine Corps, I wanted to continue helping people and thought firefighting might be a good fit — until I began my training. In many precincts, firefighters also serve as paramedics or emergency medical technicians (EMTs). So before I could attend fire school, I had to go through EMT school. That’s where healthcare came in. I wasn’t too hot on the idea of being an EMT, but as I worked through the program, my heart began to soften to the profession and to the people who made this their career. I was exposed to patients who were sick, aging, and poor. I watched phenomenal professionals perform what seemed like miracles to help them.
One day, I watched a young woman undergo a C-section. She spoke in Spanish to her husband while the physicians counted out the blood-laden towels they had used, throwing them on the floor. Another day, I watched the catheterization of a young man whose kidneys were in acute failure due to repeated drug use. The nurses handled him roughly, speaking terse words as my partner explained the concept of a “frequent flyer” to me. On ambulance runs, I encountered accident victims and dangerous situations where weapons were on the scene.
I was 26 years old. The sadness and tragedy of the human condition I witnessed was more than I wanted to bear. I didn’t feel I was cut out for this work. I still wanted to help people, but I didn’t think my personality or psyche was a good fit for a first-responder profession.
Another opportunity came along, and I steered as far away from healthcare as I could, not knowing that I’d return to it a decade later.
In the spring of 2005, I read Information Architecture for the World Wide Web. That book, along with the classes I was taking at the time, changed my life and career direction. By that summer, I’d taken a position as an intern for Eli Lilly working on their intranet portal. I evaluated search capabilities, conducting search log analysis, analyzing taxonomic structure, and reporting recommendations.
Good interface design is not pervasive in the healthcare industry. Neither is UX.
Shortly thereafter, I took another internship evaluating a public health statistical engine at Indiana University, Indianapolis. I was essentially doing the same thing: building a standardized taxonomy to support the search engine. I was back in healthcare and found the administrative and technical aspects of it fascinating.
Around that same time, an opportunity came along to work for a rural community hospital in Columbus, Indiana, as their medical librarian and continuing medical education (CME) coordinator. I wasn’t much of a librarian in the traditional sense. My first agenda was to move from print materials to online materials, essentially converting the library to a digital entity. I shadowed, interviewed, and surveyed the physicians and nurses to gain an understanding of their needs. I built a portal, figured out how to IP authenticate resources, and created a system where healthcare professionals could access information at the point of need rather than walking to a physical library. I went on rounds with physicians and nurses to capture their research needs and later scoured medical resources to answer their questions. This precluded my second master’s degree in informatics and served as the roots to my experience in the field of user experience, or UX.
I eventually transitioned to the Indiana University School of Medicine while working as a technical project coordinator. I worked in telemedicine, developed electronic health records, and created prototypes for studies. A large portion of my work at IU was in human factors to redesign clinics and shape behavior. For example, one large study I worked on involved mapping clinics to understand workflow and increase hand-washing, a novel concept even in today’s medical world.
Through all this experience, I gained an education (both formal and informal) in healthcare. I learned a lot about human psychology and the philosophy of medicine. I learned even more about UX and the craft of design. And I realized I had once again returned to the concept of helping people — just in a different way.
Beyond just making something beautiful, aesthetics serves a higher function in design.
It was a long journey, but 12 years later, I’m still working in healthcare as a UX professional. I occasionally get an itch to work in another industry — maybe something simpler where I can just build a landing page or frilly website with nice images. I rarely get very far in contemplating an idea like this before rejecting it. Still, it would be nice to work on an application or website where aesthetics took a priority, where creating something beautiful was a primary goal. That just isn’t the case with healthcare interfaces, which are rife with data tables, excess controls, and information-packed screens with little to no imagery.
Iconography is challenging in respect to ensuring the icon matches the function (or what it represents). Information architecture is deep for these applications and the cross-functional nature of the workflow makes it difficult to develop strict navigational paths. Chunking out features and functions into different screens is not always an option because efficiency is paramount (and chunking can slow the user down in reaching their goal). This often results in bloated interfaces and applications.
So why have I stayed in healthcare UX for 12 years? For several reasons.
Making an Impact
The opportunity to make an impact is the main reason I’ve stayed. I could work in e-commerce, the financial industry, or for various startups. But the bottom line in those industries just doesn’t have the same impact for me. Healthcare is just as financially driven as e-commerce or banking, but I know there is a patient on the other side of what I am doing.
I have, on occasion, had direct contact with patients. I’ve worked in hospitals where patient contact was routine. I’ve seen the devastating side of Alzheimer’s while working to integrate systems for better care in clinics. I’ve walked ICU and CVU units, hearing the quiet sobs of family members as I implemented hygienic systems to prevent hospital-acquired infections. I have crawled around on floors, networking homes for telemedicine studies for sick and elderly people. I have worked with hearing- impaired people to develop better systems and tools in managing their hearing devices.
Over the years, my contact with actual patients has decreased. I find I need that contact less than I did in the early stages of my career because I can more easily anticipate their needs, and I know the patients are there, somewhere on the other side of my work.
A Clear Need Exists
Good interface design (and sometimes good design, period) is not pervasive in the healthcare industry. Neither is UX. Many hospital systems do not even employ a UX staff, opting instead for out-of-the-box products to manage patients’ electronic records. It is still somewhat rare today to find a large staff of UX professionals working for a single health entity. Oddly enough, as the rest of the country has jumped on the user experience bandwagon, the healthcare industry still generally suffers from a dearth of UX professionals.
Whether it’s the interface and controls for an IV pump or a complicated piece of software like an electronic health record, healthcare is plagued with a lack of sound design. That was one of my early motivators and something that still keeps me in healthcare today. There is a niche to fill.
The first time I saw an electronic health record, I was horrified at how primitive the interface was, both in functionality and aesthetics. My ethnographic observations in hospitals and healthcare centers revealed a plethora of usability issues and systems that were not designed with the end-user’s goals in mind. Systems in healthcare are often driven by various agendas. Many are financially driven to ensure compliance (which maximizes compensation). Security plays a large role where an average doctor or nurse has to memorize a dozen passwords or more to log into a fragmented set of systems. Whatever the goal or agenda, good design usually falls to the bottom of the list.
Working in an industry where there is a clear need is something I have always found appealing, but there is also something deeper here. Healthcare is one of the few industries where the user is essentially forced to use your application. Other software applications, such as e-commerce apps, social networking apps, gaming, etc., have user bases who generally want to use the application. Doctors, pharmacists, nurses, and other healthcare professionals, however, did not enter their profession with the yearning to sit in front of a computer for a large part of their day. To them, it is simply a tool, and sometimes a barrier, in completing their work. Healthcare professionals are not unique in that they are required to use various software platforms to complete their everyday tasks. Enterprise software users also share this characteristic (think of your average intranet or your company’s software to manage your time card and/or benefits). But, healthcare UX has a much greater risk profile than enterprise UX. The difference between making a mistake on a time card versus making a mistake on a patient’s medication order is enormous. oor usability on an enterprise platform does not hold the same consequence as it does in healthcare, where every second spent with a computer is one more second not spent with a patient. The need to develop solid interfaces, good user experiences, and efficient means of completing tasks in healthcare is essential.
Give Me the 411
I had a routine checkup with my primary care physician recently. We always somehow get on the topic of electronic health records, and this time she turned the screen toward me so we could discuss the interface and how it works (or doesn’t) for her. The hospital network I belong to uses Epic,perhaps one of the largest out-of-the-box electronic healthcare record system in healthcare.
Aside from updated Chrome and minor differences, the screen she showed me looked pretty close to what you see below.
Once again, this comes from one of the largest healthcare record vendors in the United States. And I was astonished this is the best a major vendor like Epic can do. There was entirely too much information on the screen, the scannability was near zero, and the functionality was overly complicated for the submission and maintenance of orders.
Healthcare is a field where information is of utmost importance, and as a result, the systems and interfaces are information-heavy. There is a plethora of information (and functions) to pack into a given screen. Adding to the complexity, healthcare is a highly interruptive environment where professionals are often conversing with patients while they attempt to complete a complex task (such as ordering a lab test or medication). The ability to quickly digest information and accurately complete tasks in a highly interruptive environment becomes a major priority.
This becomes an exercise in information design and information architecture. What information truly needs to be on the screen? What information can we hide or leave out without posing a risk to patient safety? How should the information be prioritized on the screen, or how do we give it a hierarchy? Can it be summarized in brief allowing the user to dig deeper should they so need to?
All of this makes it challenging for me, like a puzzle I have to find all the pieces to and fit them together. It is a constant process of discovery, where I am always learning.
Healthcare is not the only industry that has to mitigate information overload in interfaces, but it represents one of the worst-case scenarios. In other industries (news, enterprise, etc.), a user might be able to hazard an educated guess and get it right. But in healthcare, there is so much information delivered via applications that there is little room for error.
All of this makes it challenging for me, like a puzzle I have to find all the pieces to and fit them together. It is a constant process of discovery where I am always learning. And the complexity of the information design challenges means I am never bored.
Healthcare interfaces and associated technologies are not exactly noted for their beauty or aesthetic qualities. In fact, they’re often terribly clunky, years behind current design trends, and comical in their antiquity. I see this as an opportunity to bring beautiful design to an industry where there is a dearth of it.
I admit there is personal satisfaction in taking an antiquated design and modernizing it. It is deeply satisfying for me to move from something that looks like this:
To something that looks like this:
Beyond the aesthetics, looking back and seeing the progress and iteration of a design is rewarding. To me, the whole process is similar to a restoration, like restoring an old vehicle to new beauty. I have always been fascinated with the idea of taking something old and making it new again.But beyond personal satisfaction, why is something as superficial as aesthetics even important?
A wealth of research supports the idea that aesthetics have an impact on user experience. One study showed a significant increase in enhanced performance where poor usability was persistent in the design, using completion times and error rates as measurements. High visual aesthetics even improved task completion times, speeding up users. Another study showed increased task completion with an appealing design versus an unappealing design. This study also showed higher perceived ratings of usability with the highly aesthetic design (even when the interface was not more usable).
Aesthetics obviously doesn’t override functionality. But in UX, the sum of the combined parts is greater than the sum of their separate effects. Aesthetics coupled with solid functionality equates to a greater user experience. Aesthetics plays a prominent role when it comes to user perception, though. Users are more likely to overlook minor usability issues in designs with a high aesthetic quality.
Beyond just making something beautiful, aesthetics serves a higher function in design. Until recently, it’s an element that has been largely ignored in healthcare where function and task completion trump all else. Healthcare professionals today spend as much time (or more) with the software as they do with the patients they care for. Aesthetic quality in a software platform can elevate the mood of a given healthcare worker — even if only slightly. In my exposure to UX, nowhere is this more important than in the healthcare industry.
A Lack of Good Design Principles
I often refer to healthcare systems as “Frankenstein Systems” — not only because they are usually built at various points along a timeline by different designers and developers (a trend in other industries as well), but mostly because they are inherently fragmented. On this latter point, for example, lab work is likely handled through an entirely different system (an LIS or Laboratory Information System) than the patient record, which is entirely different from the system used to bill and handle insurance coverage. A typical hospital admission could easily have touch points with six or more different systems. This often leads to a designer’s nightmare.
Fragmentation aside, even when working within a single system or platform, style guides are often nonexistent, as are good design principles, which can lead to a lack of consistency and structure in many products. This is somewhat normal in the industry. Thousands of users are victimized by poor navigational structures, completely different interfaces, and a generally fragmented experience (in the same application).
In healthcare UX, the stakes are high. When we overload healthcare professionals or give them the wrong information or the right information in the wrong order, we pose a risk to the person receiving treatment.
Consistency and structure allow end-users to develop a sense of familiarity with an interface. The less consistent and structured an interface is, the longer it will take to enable memorability and learnability. As memorability and learnability are primary usability components, an application lacking these components obviously falls lower on the usability scale.
Clarity in healthcare interfaces is a common problem as well. Confusing controls and navigational cues along with linguistic variations (i.e., labeling problems) between systems and interfaces leads to confusion for the end-user. Errors often result and efficiency is compromised. It is no small challenge to understand the different types of end-users and their linguistics.
Clarity and simplicity go hand-in-hand. Both involve the ability to determine where you are in an application, quickly determine the purpose of a given screen, and promptly execute tasks. This is a challenge in healthcare applications that often attempt to jam a dozen or more functions into a single screen. Equally challenging is explaining to stakeholders why this shouldn’t be done.
The lack of good design principles in healthcare applications is what keeps me employed and what keeps me challenged. It is rewarding to flesh out new designs while serving as a gatekeeper for good design principles in an industry that has fallen short in this regard for so long.
People Can Die…Or They Can Be Saved
Back when UX designers were still using Visio to wireframe and Axure RP was in version 4, I had begun writing what would become a master’s thesis on health information technology-induced errors. I conducted research in how technology causes errors, which often result in patient harm. This research included an integrative review of articles in the medical literature documenting health information technology-induced errors.
The research results netted 18 articles containing a total of 228 errors. Of the 18 articles identified for inclusion, 89% involved poor interface design. Of the 228 errors, more than half, 51.38%, involved poor UX .
The types of problems identified as a result of interface design were broad and represented issues, such as juxtaposition errors in selecting from drop menus, inability to find items within a system, lack of cohesion in design, and the presentation of data. When considering the UX (or the design) of health technology systems as a whole, problems such as cognitive overload, workarounds (due to poor design), the system not matching the workflow, and rigidity in system design all posed problems and resulted in some type of identified error. But “identified error” is something of an antiseptic term. In many of these instances, patients were hurt…or died.
In healthcare UX, the stakes are high. When we overload the cognition of healthcare professionals or give them the wrong information or give the right information in the wrong order, we pose a risk to the person receiving treatment. There are a number of design-related and human factors issues where the wrong design can cause errors. We can get the workflow wrong with a mismatch between the interface (or system) and how the end-user conducts their work or completes a task. We can choose the wrong device for the end-user. We can over-regulate or over-alert the user. The list goes on and on.
Healthcare UX offers me an opportunity to fix these errors. It also challenges me to avoid creating errors. This dichotomy keeps a designer walking a fine line with multiple points of focus between designing for functionality, error prevention, aesthetics, and efficiency. There is rarely a dull day, and more important, I know there is a busy healthcare professional helping a sick patient on the other side of what I do. That, to me, is meaningful and important work.
The opportunity to make an impact has largely been the main reason I’ve stayed.
Healthcare UX is a niche requiring a great deal of domain knowledge along with a technical understanding of how healthcare works. It is an field I have enjoyed thriving, and sometimes floundering, in over the past 12 years. Every industry requires domain knowledge, but healthcare runs deeper than most. As a result, I develop a greater mastery of my craft each year, leading to increased contributions, which I find immensely fulfilling.
It’s been 20 years since my failed start as an EMT/firefighter. I have the greatest admiration for those who do that work. I also maintain a great deal of empathy for these professionals as they struggle to care for people with tools that often fall short in environments offering multiple barriers. But I found my way of helping people by helping the people who help people. And on days when the design isn’t working and I am in a proverbial pixel hell, this is what keeps me going. This is why I design in healthcare UX.
Hello there! So first of all, I would like to introduce myself. My name is Lauren and I am an environmental science student. I spend time in chemistry labs testing water samples and listening to physics lectures on electromagnetism but when it comes to matters of environmental law and politics, I’m a little less educated. […]
Climate Change (IPCC)—has been at the forefront of warning humanity about the processes and dangers of human-caused global warming, there has been simply too much “reticence and caution” that has led researchers to downplay the most “extreme and damaging outcomes” that lurk beneath their publicly stated findings and pronouncements. While this has been understandable historically, […]
The Upper Thames River Conservation Authority says a troubling 2018 means they will only release about half as many hatchlings this year. Continue reading →
Donald Trump has indicated he wants to improve relations with Russia, as the US have imposed fresh sanctions on Russia for cyber-related activities. CBS News: Trump open to lifting Russia sanctions, “most likely” to meet Kim Jong Un again President Trump on Monday said he would consider lifting sanctions on Russia if Moscow were to […]
In their pursuit of returning astronauts to the Moon, and sending crewed missions to Mars, NASA has contracted with a number of aerospace companies to develop all the infrastructure it will need. In addition to the Space Launch System (SLS) and the Orion spacecraft – which will fly the astronauts into space and see them…
Nero kicks some ass in the latest gameplay footage from Devil May Cry 5. Along with a trailer, IGN also has 15 minutes of demon-slaying gameplay running on an Xbox One X. “Years have passed since the legions of hell have set foot in this world, but now a new demonic invasion has begun, and…