Bags, batteries and boxes: A qualitative interview study to understand how syringe drivers are adapted and used by healthcare staff.

Syringe drivers are medical devices that are critical for end of life care. They deliver continuous medication over extended periods of time. Their design contributes to the quality of experience for both patients and healthcare professionals. Little research has been published about the factors that influence the usability of this type of equipment for frontline users (i.e. those in direct contact with patients) and how equipment gets introduced. Understanding how syringe drivers are used in practice can help improve the design of equipment. 27 semi-structured interviews were conducted across acute hospitals, community hospitals and hospices (4 organisations in total). All participating organisations used the same type of syringe driver. It was found that frontline staff needed to adapt this equipment to fit the circumstances of use. The analysis provided examples of this happening for aspects relating to the appearance of the device (bags), accessories (batteries) and security (the lockable box).

How do health service professionals consider human factors when purchasing interactive medical devices? A qualitative interview study.

We present findings of a UK study into how those involved in purchasing interactive medical devices go about evaluating usability, the challenges that arise, and opportunities for improvement. The study focused on procurement of infusion devices because these are used by various professionals across healthcare. A semi-structured interview study was carried out involving a range of stakeholders (20 in total) involved in or impacted by medical device procurement. Data was analysed using thematic analysis, a qualitative method designed to support the identification, analysis and reporting of patterns. In principle, health service purchasing was found to accommodate consideration of equipment usability. In practice, the evaluation process was driven primarily by engineering standards; assessment of local needs did not accommodate substantive assessment of usability; and choice was limited by the availability of equipment on the marketplace. We discuss ways in which purchasing could be improved through techniques that account for social circumstances.

Can standards and regulations keep up with health technology?

Technology is changing at a rapid rate, opening up new possibilities within the health care domain. Advances such as open source hardware, personal medical devices, and mobile phone apps are creating opportunities for custom-made medical devices and personalized care. However, they also introduce new challenges in balancing the need for regulation (ensuring safety and performance) with the need to innovate flexibly and efficiently. Compared with the emergence of new technologies, health technology design standards and regulations evolve slowly, and therefore, it can be difficult to apply these standards to the latest developments. For example, current regulations may not be suitable for approaches involving open source hardware, an increasingly popular way to create medical devices in the maker community. Medical device standards may not be flexible enough when evaluating the usability of mobile medical devices that can be used in a multitude of different ways, outside of clinical settings. Similarly, while regulatory guidance has been updated to address the proliferation of health-related mobile phone apps, it can be hard to know if and when these regulations apply. In this viewpoint, we present three examples of novel medical technologies to illustrate the types of regulatory issues that arise in the current environment. We also suggest opportunities for support, such as advances in the way we review and monitor medical technologies.

Designing and optimizing a healthcare kiosk for the community.

Investigating new ways to deliver care, such as the use of self-service kiosks to collect and monitor signs of wellness, supports healthcare efficiency and inclusivity. Self-service kiosks offer this potential, but there is a need for solutions to meet acceptable standards, e.g. provision of accurate measurements. This study investigates the design and optimization of a prototype healthcare kiosk to collect vital signs measures. The design problem was decomposed, formalized, focused and used to generate multiple solutions. Systematic implementation and evaluation allowed for the optimization of measurement accuracy, first for individuals and then for a population. The optimized solution was tested independently to check the suitability of the methods, and quality of the solution. The process resulted in a reduction of measurement noise and an optimal fit, in terms of the positioning of measurement devices. This guaranteed the accuracy of the solution and provides a general methodology for similar design problems.

The challenges of delivering validated personas for medical equipment design.

Representations of archetypal users (personas) have been advocated as a way to avoid designing in isolation. They allow communication of user needs and orient teams towards user experience. One of the challenges for developers of interactive medical devices is that most devices are used by a wide variety of people, and that developers have limited access to those people; personas have the potential to make developers more aware of who they are designing for. But this raises the question of whether it is possible to deliver useful, valid personas of interactive medical device users. The aim of this research was to develop and test a rigorous, empirically grounded process of constructing personas, with the objective of reflecting on that process. Many challenges were encountered: we found that directly linking the personas to a user population was not possible and although personas were a useful tool for supporting communication and elicitation across disciplines, it was hard to make them representative when picking details that were relevant and checking accuracy. Checking the content resulted in disparate, possibly incommensurable, views. Despite this, the personas proved useful in supporting the transfer of knowledge across professional perspectives.

Integration of human factors and ergonomics during medical device design and development: it's all about communication.

Manufacturers of interactive medical devices, such as infusion pumps, need to ensure that devices minimise the risk of unintended harm during use. However, development teams face challenges in incorporating Human Factors. The aim of the research reported here was to better understand the constraints under which medical device design and development take place. We report the results of a qualitative study based on 19 semi-structured interviews with professionals involved in the design, development and deployment of interactive medical devices. A thematic analysis was conducted. Multiple barriers to designing for safety and usability were identified. In particular, we identified barriers to communication both between the development organisation and the intended users and between different teams within the development organisation. We propose the use of mediating representations. Artefacts such as personas and scenarios, known to provide integration across multiple perspectives, are an essential component of designing for safety and usability.