We Are All Designers


Raise your hand if you had to go through the Hunger Games labyrinth to score a COVID-19 vaccine earlier this year – figuring out which phone number(s)/website(s) to try, navigating it, answering all the questions, searching for available appointments within reasonable distances, and, usually, having to try all over again.  Or, raise your hand if you’ve had trouble figuring out how to use an Electronic Health Record (EHR) or an associated Patient Portal. 

Maybe you thought it was you.  Maybe you thought you weren’t tech-savvy enough.  But, a trio of usability experts reassure us, it’s not: it’s just bad design.  And we should speak up.

“Everyone everywhere: A distributed and embedded paradigm for usability,” by Professors Michael B. Twidale, David M. Nichols, and Christopher P. Lueg, was published in Journal of the Association for Information Science and Technology (JASIST) in March, but I didn’t see it until the University of Illinois School of Information Sciences (where Dr. Twidale is on faculty) put out a press release a few days ago. 

The authors believe that bad design has costs — to users and to society — yet: “The total costs of bad usability over the life of a product are rarely computed. It is almost like we as a society do not want to know how much money has been wasted and how much irritation and misery caused.”

Whatever the numbers are, they’re too high.

As Dr. Twidale said:

Making a computer system easier to use is a tiny fraction of the cost of making the computer system work at all. So why aren’t things fixed? Because people put up with bad interfaces and blame themselves. We want to say, ‘No, it’s not your fault! It is bad design.'”

He specifically referenced the vaccine example: “When hard to use software means a vulnerable elderly person cannot book a vaccination, that’s a social justice issue.  If you can’t get things to work, it can further exclude you from the benefits that technology is bringing to everyone else.” 

They’re serious about the social justice aspect, calling for “Distributed Usability Activism:” promoting “distributed usability through mass awareness leading to usability activism across society.”  They cite how user activism (e.g. Ralph Nadar) led to changes in vehicle safety several decades ago. 

Moral of the story: encourage more complaining.    

Many designers or developers would blanche at that prospect, and many of us users might shrug at the notion that our complaint would make any difference.  However, “usability is too important to be left to usability professionals.”  The authors urge that users be given both concrete examples about how complaints can lead to positive changes, and better venues (including social media) in which to air them. 

The end result, they suggest, might be a “Usability Kaizen,” likening it to the Japanese factory practice where everyone is encouraged to identify flaws and to voice suggestions.  I.e., “everyone should be involved in usability discussions, including end users.”

There are, they admit, a lot of smart people, in numerous professions. involved in the various products and processes that we use, but “a wider usability movement would remind members of any profession that regardless of their domain and efforts in making the world a better place, bad usability makes everything worse.” They remind us that: “Their complaints are valuable data if only we would listen, and if only people believe that their complaints will be listened to—and acted on.”

The authors believe that what we often view as “user errors” or “human errors” are, in fact, usability problems, asserting: “Hard‐to‐use software should be as unsuccessful as hard‐to‐drive automobiles.”  Indeed, they view the need for training as a tip-off there are design issues:

it is particularly egregious to first blame the end user for errors, and then to adopt a training regime for these users to conform themselves to a badly designed product….

…the default should be to regard the provision of substantial training as indicative of potential interface design failure.

For example, iPhones are an engineering marvel, with a huge range of functions, but did you ever need training to use your iPhone?  That’s the point.

Usability isn’t always bad because of poor design; Greg Bensinger recently wrote in The New York Times, “some things are difficult by design.”  He was referring to so-called dark patterns — “the techniques that companies use online to get consumers to sign up for things, keep subscriptions they might otherwise cancel or turn over more personal data…Think of them as the digital equivalent of trying to cancel a gym membership.” 

We’ve all encountered them.

Mr. Bensinger fears that such dark patterns “are particularly effective when used against minority groups, the poor, the less educated and the elderly, echoing offline schemes.”  No wonder Professors Twidale, Nichols, and Lueg are calling for activism.  He advocates legislative or regulatory solutions, and some may certainly be warranted, but some distributed usability activism is badly needed as well.

Healthcare, of course, is replete with both poor design and dark patterns.  Some say that healthcare is “the standard for poor UX/UI,”  despite the fact that “user errors” can literally kill patients, as well as lead to clinician burnout.

Nurses recently rated the usability of EHRs as “F,” and the reaction on Twitter was that there must not have been a lower score available.  Physicians have long felt the same.  Much was made of recent hospital pricing transparency requirements, but hospitals figured out how to use design to thwart consumers actually benefiting from them.  And how many times have you had to input the same information in doctors’ offices or sign forms you didn’t understand/couldn’t read? 

Don’t just accept it: complain, complain, complain. 

One of my favorite quotes is from Bon Ku, MD: “everything in health care is design.”  Simply put, if the design isn’t making your health better, or, at least your interactions with the healthcare system easier, then it is, at best, poor design and, at worse, a nefarious dark pattern.  Either way, we’ve got to speak up. 

Professors Twidale, Nichols, and Lueg suggest we look at usability equivalents of Fair Trade accreditation or Energy Star rating, and wonder: “Imagine what the impact might be of a Usability Star rating on a library catalogue. Or on a university’s application process.”  I’d like to imagine such a star rating on an EHR, a health plan explanation of benefits, a hospital bill, or a prescription drug warning label. 

Insert your own healthcare-related example; I’m sure there is no shortage of candidates.

Let’s all become usability activists.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.