Here's why you hate your computer

Let’s just say it: Enterprise software is the worst.

It's notorious for offering a little bit of everything — "Look at all these features!" — and being good at nothing. The software doesn't account for users' needs or the long-term impact on the organization. It's built to satisfy some Director of This-and-That's need to fill a PowerPoint that makes him look smart to his boss. 

People often think that design research is optional, but all you have to do is talk to people who use lumbering enterprise software to see what happens when you don't have an understanding of user needs.

There was a good example in The New Yorker this month. The article,  “Why Doctors Hate Their Computers” by Atul Gawande, explores how technology has affected healthcare providers as they switch from paper-based documentation to digital systems; The story focuses on a software system called Epic.

Here’s Dr. Susan Sadoughi describing her experience with the software:

“Ordering a mammogram used to be one click,” she said. “Now I spend three extra clicks to put in a diagnosis. When I do a Pap smear, I have eleven clicks. It’s ‘Oh, who did it?’ Why not, by default, think that I did it?” She was almost shouting now. “I’m the one putting the order in. Why is it asking me what date, if the patient is in the office today? When do you think this actually happened? It is incredible!

Now, Epic is a system that handles all kinds of information for patients and providers, but what Dr. Sadoughi is describing is her experience with inputting information into an online form. It may be a complex form, but we can think of it as an online form. 

When she asks why the system doesn’t assume that she’s the one who is entering the information instead of some other staff member, she’s really asking why no one has taken the time to observe how the form is actually used and to streamline wherever possible.

When she asks why she has to put in the date, she’s asking, “What is the point of going digital if you don’t take advantage of things like automatic time stamps for submitted forms? Why should doctors, whose time is so valuable, be manually entering dates and times on forms that generate them automatically?”

A form is not a conversation between a person and a machine. It’s a conversation between the person entering the information and another person who will later use that information. The software interface isn’t an end in itself. It’s the vehicle for a conversation between two or more people, and no person would ask a doctor for information that is redundant or irrelevant.

A design that doesn’t live up to that conversational standard is flawed.

I know, it’s easy for me to play backseat quarterback and be an armchair driver. It’s easy to pass judgment on a complex system that’s been developed under unknown constraints. But the article shows how software is a contributor to doctors feeling burnt out and depressed. If a system is causing the people who use it to leave their field, surely there’s at least some room for improvement.

But Epic doesn’t seem to think so (emphasis added):

Many of the angriest complaints, however, were due to problems rooted in what Sumit Rana, a senior vice-president at Epic, called “the Revenge of the Ancillaries.” In building a given function—say, an order form for a brain MRI—the design choices were more political than technical: administrative staff and doctors had different views about what should be included. The doctors were used to having all the votes. But Epic had arranged meetings to try to adjudicate these differences. Now the staff had a say (and sometimes the doctors didn’t even show), and they added questions that made their jobs easier but other jobs more time-consuming. Questions that doctors had routinely skipped now stopped them short, with “field required” alerts. A simple request might now involve filling out a detailed form that took away precious minutes of time with patients.

The comment from the senior vice-president seems blasé and uncaring. He’s even got his own term of art for this point of failure — “revenge of the ancillaries” — which suggests this is something that comes up again and again, but Epic either doesn’t care enough to fix it, or they have no idea that it’s their responsibility.

Software systems aren’t purely technical. As much as many programmers would love to practice their craft by working through a checklist of features, the fact is there are always unforeseen consequences — messy, human consequences.

Design is political. If you’re working with a company that doesn’t understand that the success of the project depends on people cooperating, then you’re in for a world of hurt.

The inability to acknowledge and account for those consequences is what makes content strategists and user experience designers want to strap on flame torches and start sharpening pitchforks.

Now, Epic was right to arrange meetings with doctors and staff to determine what questions should be included in the software. It’s important to give everyone who uses the system a voice in its creation. But it sounds like they didn’t go far enough.

If the consequence of doctors not showing up to a particular meeting is that patient care suffers and doctors’ satisfaction with their work declines, then maybe you’re not effectively communicating the value of that meeting to doctors.

And if those meetings aren’t generating an improved product, maybe a meeting isn’t the answer.

You can’t just call a meeting and develop a design system based on input from whoever happens to show up that day.

 Ron Swanson Angry

The real failure here is that the software company doesn’t understand that they’re not just making software. They’re influencing human behavior and human relationships. If you aren’t examining the psychological and social impact of your product, then you’re almost certainly not understanding the true financial impact for the client and the industry.

All this goes to show how important it is to study the unintended consequences of the forms and content we produce. Because, unlike these doctors, the people whom we’re trying to persuade to do business with us do have a choice. If we aren’t continuously improving our products and services based on real people’s needs, we’re showing people the door.

After a certain point, there is no such thing as unintended consequences — only willful ignorance.

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Kyle Bowen