How to use UX to create space for evidence-based change, reduce risk and increase compliance
I recently saw this series of tweets come through from Jacki Liddle:
Let me call attention to this part: 27 forms! I’m going to guess that compliance is most definitely affected.
I’m certain that there are very smart, caring people, who are working very hard to ensure that nurses are achieving full compliance in completing the 27 forms. All that information is undoubtedly vital to the safety of the elderly person and ensures that the hospital and all the nurses and doctors are fully informed about the patient’s needs. Some of the information will guide bedside interactions. Some of it will flow up to the nurse unit manager or higher up the management chain for reasons of demographic reporting. But in those 27 forms, there’s undoubtedly potential for high risk errors, missing data, or just simple mistakes due to the huge volume of other work that nurses do in addition to admission paperwork.
This is actually a common situation across industries. Any time a customer interacts with an organisation, information gets collected. The greater the risk of the interaction, the more information that gets collected. When you apply for a loan from a bank, they need to know all about you and your finances so they can make an informed choice about whether they will give you the amount you want.
We recently worked for a bank where we improved a very detailed on-line form used to apply for home loans. The bank needed lenders to use this form for two reasons. First, to get new customer information in to the bank’s lending management systems. Second, to comply with various data capture regulations that all banks comply with. While the lenders were using the form, the bank knew that full compliance was a challenge and that anything less than full compliance opened up lending and compliance risks.
The first thing we did was to work with bank management to understand what they had heard from lenders. Then we got some lenders and people who worked on the bank’s internal lender helpline in a room to create a timeline of activities so we could understand the place of the form in question in the wider work process. In two hours we covered a conference room wall in post-it notes (some UX cliches are true!) documenting the offical process and various pain points. Just this step was enough to give us a strong indication that it wasn’t the form that was the problem but how the form supported the wider workflow.
There were several key constraints in this project. We couldn’t change the wider workflow and we couldn’t change the underlying form software. We didn’t yet know what we could change, but at this point in the project we were happy to sit with that uncertainty.
Next, we travelled around Brisbane for a week talking to lenders in bank branches. We had them show us where they use the form and what else they were doing in parallel. By going into the field, we went from a post-it note understanding, which is like a sketch, to a full colour with movie with surround sound. Where before we suspected there were workarounds, now we knew what those workarounds looked like at a variety of different branches. We could see common workarounds and ones that were driven by specific circumstances.
We also took System Usability Scale (SUS) measures from all the lenders we met. SUS has been around since 1996 and is a very robust survey with good support in the academic literature. We report SUS measures as the mean SUS score from the participants and with confidence intervals so we can make statistically robust claims about the wider population. By combining qualitative research with quantitative measures like SUS we created a strong evidentiary base to use as we moved into re-designing the lenders form.
Because we had spoken with a wide variety of lenders, we knew which specific challenges they faced in each field on the form. Sometimes the language the form used was ambiguous, leading to poor quality or inconsistent answers. Sometimes the sort of answer the form required was too restricted to represent the range of answers customers give. And sometimes the question came in the wrong place in the form, requiring lenders and customers to flip back and forth through the form which wastes time and can lead to other questions being missed. We also knew, from our work process workshop and our field research, when incomplete answers on the lending form had follow-on effects later in the process.
Working within the constraints we faced, we redesigned the form and took it back to lenders — some who were in our first round of participants and some who were new. We had the lenders use our new form and again collected qualitative data and SUS scores from them. Both the qualitative and quantitative data showed that the new form was a big improvement. A two-tailed t-test comparing the SUS resutls from the original form to our re-designed form gave us a result of p=0.03, a highly significant improvement.
The bank was very pleased with our re-design. It’s currently working its way through to implementation. Because we collected data before our re-design and after, the bank now has a way to keep verifying that the change persists throughout the implementation path.
The twenty-seven form problem that Jacki mentioned from Nancye Peel’s talk will no doubt have some different underlying reasons to the lenders form but I’d suggest that there some similarities. As organisations change they accumulate forms. Over time, the organisation and its forms diverge. The bank was facing a compliance and regulatory risk of lenders not using the form as they became more disgruntled with it. Our evidence based re-design greatly reduced that risk by re-aligning the form, the work process, and the policy.
Work is comprised of more than just forms. There are important underlying systems, policies that are implemented to comply with legislation or to enact best practice. But there are also, always, parts of work that can change. When we work with organisations, we conduct research to understand which parts of work processes are necessary and which parts can be changed. Then we bring design expertise to bear on creating effective change. And then we gather robust qualitative and quantitative evidence show that how that change made a difference.
If you or your organisation has a challenge like the bank, or like Nancye Peel’s twenty-seven forms problem, you might need a user experience team who can gather data and create an evidence based change in your work environment that reduces risk and increases compliance. Get in touch.