In The Wild: How Field Research Improves Patient UX

When we were asked by a large health network how we could use technology to reduce their patients’ paperwork—in other words, “Kill The Clipboard”—we wondered about that clipboard:

What does a clipboard do all day?

And, more importantly, who are the people who interact with it, how do they feel, and—

what do they need to do their jobs better?

So we began to visit doctors’ offices to literally follow the clipboard. In technology, there’s an expression we use to talk about what happens outside of our offices:

• “In The Wild.”
• “Have you seen a self-driving Tesla in The Wild?”
• “How do people react when they see Google Glass in The Wild?”
• “The Wild” is anywhere the people who use your products are: the kitchen, the car, the office, the sidewalk, and so on.

As user experience (UX) designers, knowing what happens “in the wild” makes or breaks our work, because that’s where it will all happens. If we never leave our offices, we can easily miss critical elements and release a design into the wild that will ultimately fail.

New Coke

A famous example of a failed product launch is New Coke—released in the 80s, then pulled from shelves within months. Many people might remember the rage among Coke fans:

It was too sweet.

It tasted wrong.

They practically rioted and begged Coca-Cola to bring its original formula back. How did Coca-Cola fail to see what a flop New Coke would be?  

It turns out that, in the lab, tasters preferred New Coke to Coca-Cola in blind sip tests. In these tests, people would try a two sips of Coca-Cola, two sips of New Coke, and overwhelmingly prefer New Coke. According to this type of research, New Coke was the superior product.

But, In The Wild, people wanted the original Coke.

The researchers had fixated on the flavor of Coke in blind sip tests, and failed to uncover the reality of how soda drinkers really feel about soda. In reality, people don’t prefer sweeter soda when they’re drinking an entire can, but there’s more to it than that. Customers aren’t tasting cola under lab conditions, they’re experiencing it wherever they are, at that moment.

Ethnographic field research

If the researchers behind New Coke had to do it over again, they would have to start with real people in the wild. If they had given a six-pack of each product to customers to take home for a week, they would have seen the personal connection their customers had with the original formula, and how they really felt about the new product.

That’s why UX designers are dedicated to learning about what our users do, how they feel, and how they act in their natural habitat. Field research—specifically, ethnography—helps us accomplish that. In order to learn about users by doing what they do, I have ridden busses, sat in cafes, and most recently, followed medical staff and patients through doctors’ offices.

For that health network client (read: clipboard following), many of our findings confirmed things we had heard from our contacts at headquarters, but others turned assumptions on their heads, and our visits provided important details, context, and storytelling that you can’t find in a lab…or a meeting room.

We were left swimming with new ideas: now we knew real people who needed help, had visited real places where our technology would be used, and gained real stories to tell each other as we worked.

As we researched, we rapidly prototyped an app that we hoped could dramatically reduce paperwork, save the time of both patients and medical staff, provide a better in-office experience, and even improve health outcomes.

Prototype, watch, learn, improve

The prototype we designed during our field study was a tablet app. It was created to collect patient intake information at a doctor’s office in a streamlined and conversational format. We worked in heavy consultation from stakeholders and subject matter experts, including a panel of doctors whose real world experience and stories had been key to our work. Finally, we brought the tablet prototype to a doctor’s office and handed it to patients and medical staff In The Wild.

The initial reactions to our tablet app were overwhelmingly positive, with a lot of people—both staff and patients —exclaiming how “cool” it was and how it would “save a lot of time”. Younger people liked to talk about how elderly patients would feel. One patient exclaimed, “My mom would hate this!” while another said that the large type would make a huge difference for elderly patients with vision problems.

• We also gained enormous insight into how people perceived the actual hardware in real life: as soon as someone asked us, “Has this been sterilized?”, we were aware that our tablet had become a medical device—so that ensuring not only that it was it was clean and sterile, but also that it was perceived as sterile, would be a requirement.
• We watched a patient crash the app—and in fact the entire device—within seconds of receiving it, underscoring the fact that a user’s first moments with a product can make or break its success.
• One doctor held it up: “This is too heavy,” he lightly said, “and it needs a privacy screen protector.” He and other users kept swiping the app instead of tapping the “Next” button, so we also knew that the swiping interaction was a must-have for the next iteration.

When you watch users interacting with an app, they will do things you don’t expect. Here are some things we learned to include in our improved design:

• Hardware Specs: should be right-sized for the patient and be clean and sterile
• Software Specs: must enforce ease-of-use through details like large type in environments where patients may have impaired vision
• First Interaction: is the most important interaction—if patients have difficulty with their initial experience, they may never be inclined to have a second
• Available Alternatives: because patients come in all different shapes and sizes—and might need enhanced privacy or may not be comfortable using a tablet/smartphone

As an agency, we’re always focused on holistically improving both the experiences of patients and medical staff, and that requires a more complete understanding of users’ needs, context, perception, and stories. What we learn in the wild is critical to this process.