I am reading Don Norman’s classic book, the Design of Everyday Things as part of my #designthinking #adventure to learn, watch, and read all that I can about design. This excerpt struck me as particularly relevant for healthcare as he describes his participation in the assessment of the Three Mile Island Disaster:
I was called upon to help analyze the American nuclear power plant accident at Three Mile Island (the island name comes from the fact that it is located on a river, three miles south of Middle-town in the state of Pennsylvania). In this incident, a rather simple mechanical failure was misdiagnosed. This led to several days of difficulties and confusion, total destruction of the reactor, and a very close call to a severe radiation release, all of which brought the American nuclear power industry to a complete halt. The operators were blamed for these failures: “human error” was the immediate analysis. But the committee I was on discovered that the plant’s control rooms were so poorly designed that error was inevitable: design was at fault, not the operators. The moral was simple: we were designing things for people, so we needed to understand both technology and people. But that’s a difficult step for many engineers: machines are so logical, so orderly. If we didn’t have people, everything would work so much better. Yup, that’s how I used to think.
My work with that committee changed my view of design. Today, I realize that design presents a fascinating interplay of technology and psychology, that the designers must understand both. Engineers still tend to believe in logic. They often explain to me in great, logical detail, why their designs are good, powerful, and wonderful. “Why are people having problems?” they wonder. “You are being too logical,” I say. “You are designing for people the way you would like them to be, not for the way they really are.”
Norman, Don (2013-11-05). The Design of Everyday Things: Revised and Expanded
This conclusion embodies my views on healthcare and design. Just replace “operators” with “patients and “engineers” with “doctors/healthcare systems” and there you have the fundamental problem with our healthcare system.