Human Factors in Healthcare Design

Understanding human factors is essential when designing technology that people interact with, especially when you're dealing with unique healthcare populations such as the elderly. Our podcast guest is Christina Mendez, Managing Director at Human Factors MD. Christina played a role in the early development of our Spencer device and brought the human factors perspective to our design team.

We hope you enjoy listening to Christina's interview on the "People Always Patients Sometimes" podcast.

Speaker 1 (00:34):

You're listening to "People Always Patients Sometimes" a podcast production of Spencer Health Solutions. My name is Janet Kennedy. I'm really looking forward to learning something new today during my conversation with Christina Mendez. She's the Managing Director at Human Factors MD. Welcome to "People Always Patients Sometimes", Christina.

Christina Mendat (00:53):

Thank you for having me today. I really appreciate it.

Janet Kennedy (00:57):

The focus of our conversation is about human factors and some people listening will know what exactly we're talking about and others may not be so sure. So we're going to start at the beginning and can you describe what human factors?

Christina Mendat (01:12):

Human factors is the marriage of psychology and engineering. And what that means specifically is that on the psychology end of it, we understand the knowledge of human capabilities, limitations, and predispositions. And then on the engineering side of the house, we are focusing on how to apply those understandings to the design of tools, work environments, systems, hardware, and software. Does that make sense?

Janet Kennedy (01:38):

That does make sense. But let me ask you this. How did human factors even come about?

Christina Mendat (01:45):

Historically speaking? Human factors started around World War II. A lot of us think of aviation psychology during that time. This is a time when pilots were starting to have issues related to the control panels in their planes and there were some pretty scary crashes that occurred during the time. Our discipline really came on the scene to understand why was this happening, what was out of sorts when it came to the control panels and what could we do to make them better? Basically the discipline started then. They were known as an aviation psychologist or experimental psychologist. Sometimes ergonomics is also another term you might hear quite frequently. But that's where we started and that was quite a while ago. It's always interesting to me that our disciplines started so long ago, but really only embraced in the healthcare industry around the 2010 period.

Janet Kennedy (02:36):

Oh, that's so fascinating. Two of my brothers were pilots for American Airlines. And when I see pictures of them in the cockpit, I can't imagine knowing how and where and what to push the buttons. And it all has to tie into a sense of logic because you just can't have it everywhere. So that makes perfect sense to me.

Christina Mendat (02:57):

Exactly. So how should things laid out? How much information is a pilot processing at any given time? And understanding that information, where should things be placed so that it will make sense and so that they can do their job efficiently. And now we're doing very similar things in the healthcare industry.

Janet Kennedy (03:13):

Well, I envision again, a situation where we are now dealing with COVID-19 there are a lot of moving parts, a lot of pieces of equipment that need to keep people alive from the ventilators to the smart beds to all of that equipment. And it has to work well together and it has to be intuitive because even if you're trained on the equipment, but you're going from place to place to place or patient to patient to patient, it needs to be the same everywhere and it needs to be something that is really straightforward to use. You don't want to be getting the guidebook out when you're trying to deal with a crisis situation.

Christina Mendat (03:49):

Absolutely. There's one thing to engineer a product, there's another thing to engineer a product for human use, and that's what we're focusing on. We need to be engineering for humans, not vice versa, so, and how do we do that? That's what we're about.

Janet Kennedy (04:04):

Christina, how did you get involved in human factors and particularly in the healthcare field?

Christina Mendat (04:10):

Well, that's an interesting question. I ask myself that a lot. I feel like I was very fortunate to find this discipline as an undergrad, actually started as a microbiology major, so very interested in science. As I started to work on that degree, I started to gravitate a little bit more. At the time, my minor was psychology and I started to really start to learn more and more towards psychology. And at some point when I was ready to graduate, I had changed my major, like a lot of us do of course in college to the psychology of the minor is still on the micro. And I was asking myself, how can I marry more of the social science with the hard science? And so I started doing some research and I landed upon a very exciting sounding program at North Carolina State University, which was at the time called experimental psychology and ergonomics and decided that's what I was going to pursue.

Christina Mendat (05:01):

It was an absolutely perfect fit. It balanced the social and the physical sciences in a way that made me feel like, wow, what can we do with all of this? That there's so there are so many possibilities by marrying these disciplines. And during my graduate degree, I started to teach like a lot of us do. I was doing research and then I started to actually consult on the side as well for a company and really just fell in love with the consulting side. And being able to apply my learnings and helping companies really develop robust products that was taken to account human capabilities and limitations in a very meaningful way and that's where I've been ever since. A lot of us human factors professionals actually started out in software design because at the time that was very relevant. A lot of telecommunications, that's when cell phones were coming out, so a lot of us, including myself, worked in that space and through the years really started just honing in on skill sets and that's when I just fell in love with health care side of things and realize that healthcare is so broad, there are so many opportunities, there are so many lives and they can touch. There are so many products we can touch on systems we can touch on for the last close to 15 years now. That's all I've really been focused on.

Janet Kennedy (06:10):

Did the human factors come to healthcare by a natural progression of learnings or was it kind of pushed into the field because of government regulations or a need to be more systematic about it?

Christina Mendat (06:25):

I think it's a combination of both of those actually. There was some early guidance, some FDA guidance in the mid-nineties around human factors that some companies followed and some companies did not follow. Typically when the FDA releases these guidance documents, they always say, you know, this is the latest thinking and this is the current guidance. I say, no, not always a mandate if you will. But then when 2009, 2010 hit, there was a release of a new standard, which was called HG 75 and that's when it really took hold in the industry and people started taking notice that, Hey, integrating human factors in my product development design cycle is no longer nice to have it's really something that we need to be doing. And the FDA is now seeing it as a requirement. And so that's what we really started to see the big shift.

Janet Kennedy (07:09):

I think that's absolutely fascinating and I imagine a lot of this comes from watching things like the iPhone and how people totally related to the way the technology was interacting with their lives and how Apple and other software companies were really tuning into how people were using their equipment. And it wouldn't take a rocket scientist to realize we've got to make work easier for our clinicians and these are the kinds of thought processes we need to go through.

Christina Mendat (07:40):

Yeah, and really about understanding their thought processes. Right? We have amazingly smart people in this industry, not just human factors, but engineering, industrial design, you name the discipline. There are so many smart, highly intelligent people that can develop almost anything. It's so amazing. But taking that step back and understanding what are their workflows as they exist today, what are things that we can't forget that works well for them. So it's one thing to develop a disruptive piece of technology that can be very exciting, but we also need to make sure that we're still embracing those things that worked well for that group of users. It really is a delicate balance when it comes to designing a new product or evolving products. To your point, making it effective and efficient, but then also making sure it's not so disruptive that people aren't going to understand it and it's no longer intuitive.

Janet Kennedy (08:28):

I am curious about the separation based on say a knowledge base. You have clinicians obviously with advanced degrees who've had a lot of extensive training and then you have the consumer that basically has been trained on their smartphone. Do you look at the consumer's perspective? Should we not assume too much? When we're taking human factors into consideration that even though we have doctors, nurses, clinicians who've had a high degree of training, that the interfaces of these machines that they're dealing with still need to be very straightforward and really easy to understand almost without the manual.

Christina Mendat (09:07):

Absolutely. You bring up a really good point and that's something that we try to emphasize to our clients quite a lot is very intelligent people in all industries. The doctors, you know, the radiologists, the surgeons, these people are so intelligent, but that does not mean that the interface, let's just focus on a software interface for that matter, for right now, it's okay for the software interface to be highly complex because they're so smart. That person who is so smart as also contending with the environment they're working in. They're also contending with various sounds and the environment they're contending with their patient that's in front of them right now. They're trying to figure out in their mind, what should the med order be. They need to input that. There are so many layers to what these individuals are processing at any one given time. To assume that it's okay, quote-unquote, to make the interface complicated because they're so smart, that's a big fail in my book.

Janet Kennedy (09:57):

It seems that actually if you're designing technology that is intrusive, that requires the attention to be taken away from the task that the clinician really wants to focus on because they have to deal with technology that is a total fail. What it needs to be is so easy to use that it becomes just a natural extension of the work that they're doing, not a distraction from the work they're doing.

Christina Mendat (10:22):

Absolutely. Absolutely, and that's not to say that there aren't some interfaces or some products that are going to be a bit more complex. You know if you're working with a cholangioscope or something of that nature, there might need to be some complexity that I wouldn't understand. Right because that's not what I do for a living, but I should do the best I can in terms of helping design that cholangioscope for instance, that it will be as intuitive as possible for that user. To your point, they want to be focusing on that tool, but they also need to be focusing on the procedure that they're conducting at that given time.

Janet Kennedy (10:53):

When you work with clients, are you predominantly working in the B2B space? In other words, designing and looking at human factors related to tools that professionals are going to be using or do you actually help with designing things that consumers or patients might be using?

Christina Mendat (11:09):

We do both. It's pretty interesting actually. A lot of the products that we've worked with, especially for instance in the combination product space that refers to products that are a drug delivery device, say for instance, so that could be an inhaler or that could be an auto-injector or a pre-filled syringe and there are more examples. I'm just given a few. But in that space, it's surprising how many consumers are using the product as well as healthcare professionals. So a healthcare professional may be responsible for training someone on how to use that product or even administering it themselves in a clinical setting. Whereas you could also have a 10-year-old at home giving themselves an injection once weekly. We look at both sides of that because the needs could vary depending on the user group that we're focusing on at any given point for that product.

Christina Mendat (11:54):

So for instance, a 10-year-old who is administering an injection product to themselves, we might need to be very sure that we have some very robust on device labeling in case that person needs to reference it to help them with the injection. Say, for instance, that child, the adolescent, whereas a healthcare professional may want to look at different types of information that may not be on the on-device label specifically, but it might be in the prescribing information. So we need to make sure that that information is clearly provided in that form as well. So for a lot of products that we work on, actually we have to look at both sides and sometimes they have similar needs, similar capabilities that sometimes it can be pretty polarized so we have to work with that and understand that.

Janet Kennedy (12:36):

Have you had a chance to work on products that the elderly might be using?

Christina Mendat (12:40):

Absolutely. Yeah. We do that quite a lot. You know what's really interesting about that is are just the statistics themselves, right? In our research tells us that 40% of the adult population takes five or more prescriptions a day. Right? Understanding how that affects their life, their mental state and how that affects how we design a product is just as important as being able to hold something in your hand. Again, you know, not to be redundant, but there are so many layers to peel away when you're designing products and helping these companies design the best product. It can be pretty complex.

Janet Kennedy (13:14):

You know, I'm interested in looking at this over time. You're designing products and you're looking at human factors related to how people are interacting with software and you've got a generation that didn't grow up with it. They didn't even in many cases have to use it in their work lives. They literally could have been analog their whole lives and then two generations from now, that's our "digital always on" generation, and I wonder how the technology in 20 years or 30 years will look versus the technology that we're designing now.

Christina Mendat (13:50):

Yeah, I mean that's something that can be quite a struggle right now because we are at that weird point right now where we're working with the older adults and even the elderly, to your point that is just learning software interfaces, are still have never really interacted with them because one, they might be fearful, no one's ever really shown them. There could be socio-economic status issues. I mean there are so many different things that could affect that and I'm not just trying to generalize. Obviously I was really interested, I found an article the other day that was saying that reportedly, you know, approximately 60% of older adults are now using the internet.

Christina Mendat (14:22):

But what was interesting about that status, despite the 60% usage, a great majority of those individuals still reported that they feel uncomfortable with technology and they don't feel proficient. When we think about software products, that could be an embedded software interface or a standalone software interface, how do we, again, not to be redundant, but strike that balance where that product is usable for someone in their seventies but equally usable for someone in their twenties meaning that you're not alienating the 20-year old that thinks they're super savvy and wants something fresh and sexy. Yet you also have the seven-year-old you don't want to alienate in terms of making it too complex either.

Janet Kennedy (15:01):

It's a very, very fine balance. Yeah. Well before we wrap up, I did want to ask you a little question about Spencer. Sure. Because you were involved in the project of the human factors design of spencer and what kind of things did you keep in mind as you were designing and what kind of observations do you have about how Spencer turned out?

Christina Mendat (15:23):

Spencer was a really fascinating program and multi-year programs, so it really just demonstrates how much that company is really focused on the patient experience and you know, I applaud them for doing that and we don't always see that in this industry. We would like to, but it doesn't always happen, but I did. I learned a lot from working on that product as human factors professional, you come into these things and I don't want to say that we think we know it all because we know we don't. That's why I never call myself an expert. I learned something new every single day and Spencer is a great example of that. You had some individuals, I'd have a 75-year-old person that could come in, use the interface just fine. Really no issues really early on in the prototype phase. That's when we're still just trying to work out the kinks. Not a problem, then I could have a 55-year-old come in and just struggle. It really just highlighted that I don't want to speak cliché and say age is just a number, but the experience is really the key. So that 75-year-old had a tremendous experience with iPhone, Android, all of that type of stuff. Worked with her daughter until she really felt proficient, really had the drive to understand and want to learn how to use these types of interfaces. Whereas I had a much younger participant who really, really struggled and so I'm trying to understand what that was about and it really just came down to experience still to your point, I wanted to come back to that cause I still was working on a flip phone and there's absolutely nothing wrong with that. But again it comes back to that theme. I think that's emerging here is trying to balance these types of experience levels can be difficult.

Christina Mendat (16:52):

So we needed to be able to bring that into the interface so that those users could still use the product without any errors. And you know, that's the important part about spencer is while errors aside, they're depending on this for the medication. And we know medication adherence is a problem and that's the whole premise of this product dispenser. So how do we ensure that this interface is going to give them the information they need to one, be able to use it and be as intuitive as possible, but two know when their medication has been provided. Basically what we learned ultimately, and some of it might seem a bit of common sense, but was really decreasing the depth of menus. Again, that can kind of be common sense, but when you have a product that really doesn't have very deep menus in the first place, you have to be smart about it.

Christina Mendat (17:38):

And that's what we really had to do. We had to really think this through, okay, let's group this information a little bit differently so that we don't have such deep menu items if you will. So that was one of the big learnings that we had to do. And, and in some cases, we actually had to pull some functions out of places where we thought was very intuitive. We said, yep, this feature should go in here. It makes complete sense. That's the way it is on a number of other products. But then when we started working with these users, we realized actually it did not make sense here and so we'd have to move it to a place that actually made sense for these users. And ultimately we think it developed a fairly seamless experience. But there are a lot of different things that we learned from this experience and really about going against sometimes what you thought was best and really, really truly listening to the users and what was going to be meaningful to them when they go home and use this because, remember, even if people are given training at some point, and I imagine they will be for this product, could be by a pharmacist, it could be by a healthcare nurse. They're going to try to come to some training, but that doesn't mean that they're going to retain that training a week later, a month later. It also doesn't take into account their medical condition and potential complications that they have as a result. Are they having any memory issues? Do they have any physical limitations that could affect their interaction with the screen? So again, back to those layers. We needed to bring all of that into the know as we develop this interface.

Janet Kennedy (19:00):

Do I get to give you credit for the personality of spencer?

Christina Mendat (19:05):

No, I don't think so. I wish I was just a helper. I'm not a product developer. We just give them information, so I wish I could do that. I just gave them information that we hoped was helpful at the time. I can't say that I gave them the personality. I would love to take that credit, but I think that's some other folks that are in the midst and accountable for that.

Janet Kennedy (19:27):

Well, I can't thank you enough for being here, Christina. I have always been fascinated by the idea of human factors but didn't honestly understand the thought process that went into it. Talk about a field that is evolving as human beings evolved. It must be fascinating work. It is. It's very rewarding and I wouldn't trade it for the world. Well, I thank you very much for joining me here today, Christina.

Christina Mendat (19:50):

Thank you for having me, Janet.

Janet Kennedy (19:52):

Thanks for downloading this episode of "People Always, Patients Sometimes" if you've enjoyed our conversation, please drop a review or a rating in iTunes and that will help us find more listeners. This podcast is a production of Spencer Health Solutions.