How do you design for different levels of technical expertise in a medical device?

When should you translate design ideas from paper into physical models?

Today we’re sitting down with Damein, an industrial designer, to discuss his experience designing medical devices and tips for creating a successful product.

 

Damein

I’m an industrial designer and usability expert here at Blur. I help to bring the voice of the user, their needs and constraints, into a conversation early on so that when we’re designing a product it doesn’t get designed only from the inside out but also from the outside in.

Julia

Have you ever seen a product where that happens, where they don’t start with the user needs and sort of what were the ramifications of that?

Damein

We’ve all seen those things, like when you look at something and think, “This is going to be really nice.” For instance: this microphone. We were just trying to plug the cord into it but the cord plugged into it is sort of cumbersome and difficult to access. That could have been a consideration made early in the process, thinking how does this thing plug in, how does it go together, and how is that experience going to be interpreted by the user? Are they going to get frustrated and just get a better microphone, or are they going to press through that problem and make it work? 

We always want to when we’re designing something, especially early in the process, ask who’s going to be using this thing? How can we champion that user throughout the process so that every step we take and every direction we go we’re always looking back and asking how it’s going to be used? That informs a lot of decisions that we have to make in terms of what shape it needs to be, can a person hold it, can a person operate it, can you reach the buttons, do you have to go back five screens to get back to where you need to be? Those sorts of considerations are really important and you can’t really have those if you’re zoomed in so close to a problem. It’s important to always look back up and ask, “Does this matter to the person who is going to be using the product?”

That’s something that we try to do at Blur and infuse into our design process, having that design consideration for the person who is going to be using the product and not getting too caught up in the technical details and feasibility too early on. Before asking, “Does this work [technically], how are we going to do it?” we make sure first that it will work for the person we’re designing it for.

Britt

And what kinds of questions do you start out with our clients? High level versus detailed to get to what you said, even with plugging in the microphone, what questions could they have asked or thought of to mitigate that?

Damein

When we’re talking to a potential client who has a really great idea, or a technology that they’ve developed, they often want help getting it off the ground. We start with stuff that is super high-level: Tell me about who is going to be using it and what does it do? What are we actually trying to achieve and what’s the goal for the product, and then what’s the goal for the user? Sometimes the user is a different consideration than the person that the product is being used on. Especially in a medical device space, where you have maybe a clinician or nurse or surgical assistant using the device on a patient. The experience for the surgical assistant or the clinician is going to be a lot different than the patient’s experience. Making sure that they have considerations on both sides of the equation [is important]. 

When I start, I start with who is using the product? Is that person, the primary user, also the patient or secondary user? How does that experience go? Sometimes you’ll have a product that the primary user is the patient, but the secondary user would be the clinician who sets it up, hands it to them, and then performs whatever function they need to perform. 

I start with those two profiles and try to understand approaching it with that mindset, and then you look at the workflow. How is that workflow going to go? Do you need to unbox it? Does it need to be paired to something? Are there speakers and buttons? Does it need to be shrouded so it stays sealed and stays clean and sterile throughout the use case? Those are all really important things that we need to know upfront because if you have to put a drape over top of a product, and you also need to have buttons or an interface underneath of that drape, we’re wearing two pairs of gloves, we have a drape, and now we’re trying to push a button underneath of that drape. So, what kind of button is that going to be? It’s probably not going to be a touchscreen, it’s probably not going to be one of those capacitive microwave buttons. It’s going to need to be something relatively chunky that gives good feedback and has a tactile feel so that when you’re pressing it, it’s deliberate, intentional and thoughtful. 

Julia

As you’re designing products for multiple different users, there’s also different levels of technical expertise that you have to weave into these products. How do you balance that? Say you have a user that really doesn’t have much technical expertise on this very technical thing, even potentially life-saving medical devices. I think about an epipen, someone has to look at that and know how to use it right away because there is very little room for error. If there is an error, that’s potentially costing someone their life. How do you balance that as you’re thinking about these questions in the beginning of a design?

Damein

Not everyone has the ability to look at a product and understand how it functions right off the bat. What you want to do is make sure that it’s designed in a way that is intuitive in that direction. If it’s an epipen, one side is always going to be pointy and one side is always going to be blunt, so that makes a lot of sense for [telling a user] “This Side Down.” If you have a basic understanding like me, who’s never used an epipen before, in an emergency I could pick up that device and say, “All right, I know I have to put what’s inside this syringe into this person, so I’m going to stick them with the pointy end.” That helps you to understand how that product functions. Whereas, if it were a rectangular shape or any other sort of shape, it might [spur questions]. Do I do it this way or do I do it that way? Is this like a glowstick, am I supposed to crack it? How does this work?

Designing the form of something can really help inform how a user is going to perceive it and then how a user is going to end up using it. Everyone is going to tackle it for the first time without looking at an IFU. Even though we don’t condone that and we say they should read it, sometimes they don’t. You want to make a product that is going to be safe and effective even if there is an uninformed user. 

Britt

In manufacturing and service, I can think of a lot of things that if I could tell someone what I learned from, I would tell them these mistakes and what I did to prevent that in the future.

Damein

Sure, one thing I would say you want to steer clear of is making assumptions. I know that’s sort of a baseline thing, but especially making assumptions about how someone is going to intuitively use a product. We talked about intuitive use cases where you have a product that looks like it does a function, so form is following function in that case. To me, the designer, the client who had the idea might have had preconceived notions about how if we hand it to a third party, someone who has never seen the device before, how they’re going to use the device. 

We can get the whole way down the process, have a great thing, say, “Look how cool this is! Look how well it works!” and then hand it to someone who’s never seen it before and they hold it upside down. 

Britt

I’ve seen you at Blur give [prototypes] to several different people at the office and say, “Use this,” and they do

Damein

And that is something I really value about being at Blur is that our team operates in a way that they can take a product or project and run with it. You can take this to someone else who has literally never seen this technology before and say, “Hey, look at this cool thing we’re working on. Can you just hold this?” You’ll learn so much, and it’s about that physical interaction. 

You can send out Google surveys, multiple choice questions, but there is so much in the intonation of having a conversation with somebody, watching them hold the product or watching them try to set up the device that is really huge. They’re making a mistake, you’re just watching, and they don’t even know they’re making a mistake. I can then go back to the drawing board and ask questions. Maybe it’s less comfortable to wear it that way, or maybe it doesn’t fit together like that, and make it in a way that it won’t even work [if they put it together incorrectly], so it’s not an option and it’s not a problem.

Julia

How do you elicit the correct emotion from someone? Say you’re using a product and you talked about red as being this very alarming color, this goes maybe more into the UX or UI design, but just being very aware of not just the physical use of something but also how is the person feeling as they’re going through this process? If someone’s using an epipen they’re probably going to be pretty anxious, so it needs to be fairly foolproof in the way that they use it. How do you incorporate that into your design as well?

Damein

In medical devices it’s an interesting issue because you’re dealing with high stakes situations, and oftentimes life-threatening situations, and adrenaline can be pumping and it’s really sort of an intense time, even for trained professionals. On some of the devices that we’re developing, seconds can matter. Getting an infusion on time, moving a millimeter to the right and getting the wrong artery, these are things that are really important. 

[You have to be] cutting a balance between alarming someone and telling them something bad is happening versus alarm fatigue, which is a real thing in the industry where if you’re in an OR, there is constantly something beeping at you. There is constantly something trying to get your attention and flag you down, so you have to be sensitive to that environment and alarm on things that are actually alarms. Not just low batteries. Really sort of playing with that threshold of what is actually an emergency and what is something you can deal with after the real emergency is over? 

When you think about that, you think about, “Do we need to use a red light here? Or would an orange do?” There’s also things you have to do with some regulations, like in 60601 testing you need to be sensitive to what their alert system is and what can and can’t be in that bucket. There’s a lot of different things you have to consider when you’re thinking about how to grab someone’s attention, and what level of that attention you need to grab depending on the class of the device, use case, and the scenarios you’re in. 

Julia

Can you walk us through your ideal timing and timeline for the start of a design project all the way through the end?

Damein

Well, the start is not always the start and the end never ends. Ideally, you would get a cross functional team together: someone who is in the design space and represents the user, someone who is a technical lead, whether that’s a mechanical, electrical, or software engineer depending on what the project’s needs are going to be, and you get the client in the room to lay out the problem you’re trying to solve. What are our goals? What does success look like? We put together a road map of how we would like the project to go. It almost never goes how we want it to go, but we can get close. 

We get that cross functional leadership team together, which is really important because I might not always throw out ideas that are perfectly feasible. If we have someone else in the room to say it might not work, or they have an idea for a different type of technology to supplement what we need to do, it’s important to have that organic transfer of ideas and information. 

After we understand our baseline roadmap, the design team will take that and start throwing stuff at the wall. We’ll have a brainstorming session and start understanding the strengths that we have, the goals we have, and proposing different ideas of how to get there: different technologies, different forms, different things to solve the problems we want to solve. 

We can really explore a large swath of those ideas pretty quickly with fast and dirty CAD models, sketches, renderings, any tool in our tool belt, sculpting foam, and making volumetric studies. We refine it down and I like to see at least five good ideas, usually it’s three, but if we can get five good ideas that go from our most conservative concept that just absolutely solves the problem without taking too much risk all the way to the pie in the sky, something that will shake up the industry or change peoples’ lives.That sort of spectrum is always nice because when we present that to the stakeholders, they can pick the parts they like from each one. They can mitigate the risk with the conservative features and maybe up the perceived value with some of these more interesting ideas on the other end of the spectrum.

Then we go back and explode out what we have. We take the ideas we have, what they wanted, and we put them into new concepts. We push those boundaries to get past the low-hanging fruit, the initial exploration, and into something that is really digging deep and grabbing those good ideas right at the top of the tree. You have to climb high for them, but once we get there we can show three solid directions and the client can pick the one they like the best. 

Then we can move into mechanical design and understand all of the intricacies of how we’re going to design this for manufacture, how we’re going to design it for assembly and get Britt’s team involved. [They’ll tell us] how exactly to set up an assembly line, how many times do we have to flip this thing over to make it work? We can really find some efficiencies in that space, but design sort of tapers off there, where the engineering starts to grow. We have this symbiotic relationship where we don’t really hand it off, but it sort of flows. One process leads into another, so we go from design to engineering to usability studies and then manufacturing. 

Throughout that whole process, there’s designers involved making sure that the vision is maintained, we’re always pushing boundaries and never just accepting the status quo, thinking of new ways to do things and implementing new techniques to achieve the problems we want to achieve. Otherwise, you might get stuck with “good enough” when it could have been a lot better. We never want to be in the position where we’re just settling.

Julia

How do you differentiate between something that is a good idea and something that is a great idea? Do you have questions you ask? I know that’s dependent on the goal of the client, but how do you keep that in mind as you’re having this very exploratory phase at the beginning?

Damein

Sometimes great ideas turn out to be bad ones, and sometimes what you think won’t be good ideas are actually pretty good. 

That’s sort of a non-answer, but it’s kind of a gut feeling when you’re designing something. It’s like, you start sketching something, you start doing a CAD project to understand how things will go together and sometimes something will click. You can feel it in your gut that that is a good direction, and you can feel that flow when you start pushing even further in that direction, and you can come up with something that is, hopefully, really ground-breaking on the other side of that effort. 

Sometimes you’re doing it and you think, this is okay, but I don’t know. You never want to kill something too early because down the line you might want to pull it back up. In fact, right now on a project we’re working on, we’re struggling with how to attach this cartridge to the side of this piece of equipment. We had been doing it one way, but we had to change a couple of things about how they went together. We remembered a couple of weeks ago we had this idea where we would hinge from the bottom. Can we resurrect that? At the time it didn’t make sense, but now that we’ve had these adjustments in the design and some constraints around the engineering, it makes a lot more sense. We can revive that old idea, dig up those prototypes out of the bins on the shelf and now we don’t have to retread that and start from scratch. We have a bit of a leg up. You never really know, sometimes they come back.

Julia

Back to haunt you. 

Damein

Or save you!

Julia

We’ve talked a lot about this exploratory phase and getting a lot of these ideas down on paper. How do you move from paper to where you’re actually getting user feedback

Damein

Absolutely. That’s a really critical part of the process and specifically our process here at Blur. You want to get designs out of your head and into your hands as quickly as you can. That route from A to B needs to be a straight line, if at all possible. So, when you have an idea you might sketch it or do a quick CAD model. Basically, in the ideation phase we don’t restrict designers to make them just do sketches, or just do CAD work, or just do renderings. We want to get any and all visual physical communications out, whether that’s a piece of foam that’s sculpted into a shape, or a 3D printed version of CAD model. It’s really important to get those things into three dimensions so we can actually hand it to that end user, to that stakeholder, and say this is what we’re thinking. If a picture’s worth a thousand words, a model’s worth a million. 

It’s wild, you can have something on a piece of paper but once you hold it in your hand everything becomes so much more clear. You really understand, oh, it looked this big on paper but when you hold it do you really want this thing to run for 24 hours straight? It’s pretty big. Those sorts of constraints become very relevant and very obvious when you have them in three dimensions. 

Really for our process, we try to get things off the page and into your hands as soon as we can because you can make so many more informed decisions about what you’re actually building that way.

Julia

What’s one of your favorite projects that you’ve worked on here at Blur?

Damein

One of the more rewarding projects I’ve gotten to work on during my time here at Blur was a surgical robot that really helped pave the way for a lot of the surgical robotic equipment that is being developed now. What was so interesting about it is there are so many different users, and there are so many different constraints around each user. You have a surgeon, you have a surgical assistant, you have a patient, and you have a scrub nurse, and they all interact with this device in different ways at different times for different reasons. 

The device has three main components: a central unit that drives the instruments, an endoscope, which is a camera on the end of a snakey tube, and an insertion tube or the part that goes into the patient. Our main focus was the central unit and how that interfaces with the endoscope and the insertion tube for the instruments and endoscope. You have three challenging mechanical interfaces that have to remain sterile, that have to be intuitive and usable in almost a blind way because you can’t see what you’re doing when it’s in position, and it’s used by those three users. They all have different needs. On top of that, the whole thing is draped in plastic. So, you have to be able to feel what you’re doing, see what you’re doing, and have the human factors in a way that is always intuitive and easy to access. 

That was a really challenging project, but I think we were able to come up with some really innovative, elegant, and thoughtful solutions for the way that we approached it and how we got those challenges solved for the client. 

Julia

Do you think there’s anything you learned from that project or solutions you came up with that you find yourself coming back to for other projects? Are there any lessons you learned that you can implement into your work going forward?

Damein

I think some of the biggest learnings I gained from working on that project is understanding the importance of working in that cross-functional team. It wasn’t really specifically related to the design, but because it was such a big project there were lots of engineers and designers working on it. We all had to work in a very small space virtually: we’re working on the same CAD models, adjusting the same dimensions. We really had to mind-meld to drive to where we want to be as far as the solution we’re looking for. It really drove home for me our workflow and having these teams work as one consciousness almost, this hive-mind of engineering to achieve a goal. We learned a lot about what works well and doesn’t work well in those challenging, intricate projects that require a lot of effort but a lot of dexterity.

I really love working here, honestly. We have such an amazing team of talented engineers and designers and people working together that it makes it easy to really dig into these hard problems. A challenging project doesn’t feel so daunting when you’re backed up by an incredible team. For me, when a big project comes in the door I’m chomping at the bit to check it out and dig in to see what’s going on because I have someone sitting right next to me, or right behind me, or right across from me who can answer any questions I might have. As a team we can knock it out of the park. That’s been something that’s been really rewarding for me about working at Blur and with this team specifically. 

Julia

We are super collaborative here, which I appreciate a lot as someone who is not on the engineering side of things. I can ask any questions I have without feeling like I should know [the answers].

Damein

There’s a lot of questions I ask that I feel like I should know, but no one ever says anything. 

Julia

Yeah, thanks for sitting down to chat today.

Damein

Absolutely, thanks for having me.